Possibilities and shortcomings of maintenance therapy in gastroesophageal reflux disease

An overview is given of the current possibilities and shortcomings of medical therapy in reflux disease. With H2-receptor antagonists and prokinetics, roughly 60% of the patients can be maintained in remission; with proton pump inhibitors, remission can be maintained in approximately 90%. Whether there is a specific symptom pattern that benefits from cisapride is insufficiently evaluated. H2-receptor antagonists insufficiently reduce food-stimulated acid secretion and suffer from a degree of tachyphylaxis. Proton pump inhibitors suffer from acid rebound and occasionally cannot prevent nocturnal acid breakthrough. In general, medical intractability is virtually nonexistent with the current pharmaceutical possibilities and is therefore no longer per se an indication for surgery.