Gastroesophageal reflux disease. The long and the short of therapeutic options.

Gastroesophageal reflux disease (GERD) is a common and treatable condition. Initial therapy includes lifestyle modifications, avoidance of certain medications, and use of antacids, alginic acid preparations, and over-the-counter histamine2 (H2) receptor antagonists. Escalation of therapy for acute disease relies primarily on H2 receptor antagonists given in conventional dosages. Although H2 receptor antagonists remain the cornerstone of therapy, sucralfate and promotility agents, especially cisapride, may offer alternatives. Most cases of GERD that are resistant to these therapies can be reliably healed with proton pump inhibitors (PPIs). Patients whose GERD is healed with one of the aforementioned agents often relapse unless they receive further therapy. For patients with mild disease, H2 receptor antagonists, cisapride, or a combination of the two may prevent recurrent symptoms. In severe disease, PPIs are the agents of first choice, but concerns about the safety of long-term use must be considered. In selected patients, surgery offers an option for long-term control of GERD. With present surgical techniques, symptom relief can be obtained with little risk of complications.