Strategies for medical management of reflux disease

Peter J. Kahrilas*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Management of gastro-oesophageal reflux disease (GORD) patients must consider two issues: (i) how to optimize the treatment of a presenting symptom complex, and (ii) how to manage risk of adenocarcinoma associated with GORD. In most cases the need for, and potency of, pharmacological therapy used is decided by symptom assessment. Considering cost effectiveness, the three increments of pharmacological therapy are: (i) generic histamine2 receptor antagonists, (ii) standard dose proton pump inhibitors, and (iii) higher dose proton pump inhibitors. Endoscopy is warranted if there is doubt regarding the diagnosis of GORD or if the patient relays alarm symptoms suggesting more ominous diagnoses (dysphagia, bleeding, weight loss, odynophagia). The other major indication for endoscopy is to screen for adenocarcinoma or Barrett's metaplasia in the patient with chronic symptoms. In most patients, the need for maintenance medical therapy is determined by the rapidity of symptom recurrence during a trial period off the medication.

Original languageEnglish (US)
Pages (from-to)775-791
Number of pages17
JournalBailliere's Best Practice and Research in Clinical Gastroenterology
Volume14
Issue number5
DOIs
StatePublished - 2000

Keywords

  • Disease management
  • Gastro-oesophageal reflux disease
  • Oesophageal adenocarcinoma
  • Oesophagitis
  • Proton pump inhibitors

ASJC Scopus subject areas

  • Gastroenterology

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