Therapeutic options in the management of gastroesophageal reflux disease.

The treatment of gastroesophageal reflux disease requires an individualized approach, and aims to remove the symptoms, to heal the esophagitis, and to prevent the recurrence or complications. These objectives are obtained reducing the incidence of the damaging reflux into the esophagus by improving the anti-reflux barrier, decreasing the gastric acid component, enhancing the esophageal clearance. Depending on the severity of the disease, gastroesophageal reflux disease may be managed through a combination of lifestyle modifications, antacid-anti-refluxant drugs, prokinetic drugs, receptor-H2-antagonists, proton pump inhibitors or surgery. Antireflux surgery should be considered in several situations. All patients, especially at a young age, who have an insufficient response to medical management, presenting with a mechanically defective lower esophageal sphincter or with various grades of complications are candidates for surgery. Although a surgery is rarely used as treatment option in patients affected by gastroesophageal reflux disease, the percentage of success is upper to 80-90%, especially after the introduction of minimally invasive procedures, with significantly ad vitam reduced costs.