Gastroesophageal reflux disease. Selecting optimal therapy.

An understanding of the pathophysiology of gastroesophageal reflux disease should aid selection of appropriate therapy. Symptoms of mild reflux disease may be controlled by traditional management (ie, elevating the head of the bed, dietary and other lifestyle changes, antacid use). These conservative measures also should be encouraged in patients with complicated disease. Prescription histamine2 (H2) receptor blockers remain the mainstay of antireflux medical therapy. Use of prokinetic drugs and H+,K(+)-ATPase inhibitors may be considered in refractory cases. A small percentage of patients may require antireflux surgery. If over-the-counter preparations of H2 blockers become available, they would likely become a popular component of conservative therapy.