Pharmacologic strategies for treating gastroesophageal reflux disease

Objective: This paper presents a synopsis of the pathophysiology of gastroesophageal reflux disease (GERD) and the efficacy, safety, and cost of the agents commonly used in its treatment. Background: Symptomatic relief of GERD can be obtained with lifestyle changes (avoidance of factors that may exacerbate symptoms, such as overeating and use of alcohol and tobacco) and use of over-the-counter medications such as antacids or histamine-2 (H-2)-receptor antagonists. When these measures are unsuccessful, treatment with prescription-strength medications is required to prevent complications, such as Barrett's esophagus or esophageal adenocarcinoma. Methods: Current guidelines for the management of GERD were identified through a MEDLINE(R) search of the English-language literature from January 1995 through December 1999 and a search of the bibliographies of identified articles. Conclusion: Patients who do not respond to initial therapy should be managed with prescription-strength H-2-receptor antagonists. Endoscopy should be considered for patients with atypical or refractory symptoms, patients with a confirmed diagnosis of refractory GERD, severe esophagitis, Barrett's esophagus, or peptic stricture should be treated with and maintained on a proton-pump inhibitor.