Treatment of Gastroesophageal Reflux Disease*


Aim of the review and methods:

This review brings together information on the treatment of gastroesophageal reflux disease. Published manuscripts were identified from Medline. The articles were then screened for relevance prior to inclusion in the review.

Results and conclusion:

Up to 40% of people in Western countries are estimated to regularly experience heartburn, the most characteristic symptom of gastroesophageal reflux disease (GERD). Treatment options available for GERD range from over-the-counter (OTC) antacids to proton pump inhibitors (PPIs) and anti-reflux surgery. Many patients self-medicate with OTC medications such as antacids and low-dose histamine H2-receptor antagonists (H2RA) to relieve episodic or food-related symptoms of GERD, and may not seek medical advice unless symptoms persist or worsen. However, GERD is a chronic disease that frequently affects health-related quality of life and, if not properly managed, the complications of GERD may include erosive oesophagitis (EO), Barrett’s oesophagus and adenocarcinoma.

Adequate control of acid secretion is key to the successful treatment of the condition. OTC medications provide effective symptom relief to about one quarter of patients suffering from GERD. H2RAs can also provide effective symptomatic relief, particularly in patients with milder GERD, but become less-effective over time. PPIs are the agents of choice for the suppression of gastric acid production and have become the mainstay of therapy for acid-related diseases. PPIs produce significantly faster and more complete symptomatic relief, significantly faster and more complete healing of erosive GERD compared with H2RAs and are also significantly more effective at preventing relapse of EO.

There are a number of existing guidelines for the treatment of GERD. Recommendation for initial therapy consist of general measures, such as lifestyle advice in combination with antacids and/or alginates. When general measures fail, the next step is empirical therapy. Two options exist for the expirical treatment of GERD, so-called “step-up” or “step-down” therapy. There are no clear data to support either treatment strategy as a universal approach to all patients; consequently, physicians must always choose the course best suited to the individual patient.

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  1. 1

    RC Heading (1989) ArticleTitleEpidemiology of oesophageal reflux disease Scand J Gastroenterol Suppl 168 33–7 Occurrence Handle2617176 Occurrence Handle1:STN:280:DyaK3c7ktVCrtw%3D%3D

    PubMed  CAS  Google Scholar 

  2. 2

    SJ Spechler (1992) ArticleTitleEpidemiology and natural history of gastro-oesophageal reflux disease Digestion 51 IssueIDSuppl 1 24–9 Occurrence Handle1397743

    PubMed  Google Scholar 

  3. 3

    M Hollenz M Stolte J Labenz (2002) ArticleTitlePrävalenz der Refluxkrankheit in einer Allgemeinpraxis Dtsch Med Wochenschr 127 IssueID19 1007–12 Occurrence Handle10.1055/s-2002-28325 Occurrence Handle11997867 Occurrence Handle1:STN:280:DC%2BD383lslKmuw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  4. 4

    JA DiPalma (2001) ArticleTitleManagement of severe gastroesophageal reflux disease J Clin Gastroenterol 32 IssueID1 19–26 Occurrence Handle10.1097/00004836-200101000-00006 Occurrence Handle11154163 Occurrence Handle1:STN:280:DC%2BD3M3kt1Kgsg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  5. 5

    J Behar DG Sheahan P Biancani HM Spiro EH Storer (1975) ArticleTitleMedical and surgical management of reflux esophagitis. A 38-month report of a prospective clinical trial N Engl J Med 293 IssueID6 263–8 Occurrence Handle237234 Occurrence Handle1:STN:280:DyaE2M7nsFWlsg%3D%3D Occurrence Handle10.1056/NEJM197508072930602

    PubMed  CAS  Article  Google Scholar 

  6. 6

    DA Lieberman (1987) ArticleTitleMedical therapy for chronic reflux esophagitis. Long-term follow-up Arch Intern Med 147 IssueID10 1717–20 Occurrence Handle10.1001/archinte.147.10.1717 Occurrence Handle3116959 Occurrence Handle1:STN:280:DyaL1c%2FitlSqsQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  7. 7

    JQ Huang RH Hunt (2001) ArticleTitlePharmacological and pharmacodynamic essentials of H2-receptor antagonists and proton pump inhibitors for the practising physician Best Pract Res Clin Gastro- enterol 15 IssueID3 355–70 Occurrence Handle1:CAS:528:DC%2BD38XhvV2huw%3D%3D

    CAS  Google Scholar 

  8. 8

    DG Colin-Jones (1995) ArticleTitleThe role and limitations of H2-receptor antagonists in the treatment of gastro-oesophageal reflux disease Aliment Pharmacol Ther 9 IssueIDSuppl 1 9–14 Occurrence Handle7495945

    PubMed  Google Scholar 

  9. 9

    Olbe L, Cederberg C, Lind T, Olausson M. Effect of omeprazole on gastric acid secretion and plasma gastrin in man. Scand J Gastroenterol Suppl 1989; 166: 27–32; discussion 41–2

    Google Scholar 

  10. 10

    CH Wilder-Smith T Ernst M Gennoni et al. (1990) ArticleTitleTolerance to oral H2-receptor antagonists Dig Dis Sci 35 IssueID8 976–83 Occurrence Handle10.1007/BF01537246 Occurrence Handle1974493 Occurrence Handle1:CAS:528:DyaK3MXhsleltg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  11. 11

    C Wilder-Smith F Halter T Ernst et al. (1990) ArticleTitleLoss of acid suppression during dosing with H2-receptor antagonists Aliment Pharmacol Ther 4 IssueIDSuppl 1 15–27 Occurrence Handle1983344 Occurrence Handle1:CAS:528:DyaK3MXhslelsg%3D%3D

    PubMed  CAS  Google Scholar 

  12. 12

    JG Hatlebakk A Berstad (1996) ArticleTitleGastro-oesophageal reflux during 3 months of therapy with ranitidine in reflux oesophagitis Scand J Gastroenterol 31 IssueID10 954–58 Occurrence Handle8898414 Occurrence Handle1:CAS:528:DyaK28XmtlOgtbo%3D

    PubMed  CAS  Google Scholar 

  13. 13

    L Lachman CW Howden (2000) ArticleTitleTwenty-four-hour intragastric pH: tolerance within 5 days of continuous ranitidine administration Am J Gastroenterol 95 IssueID1 57–61 Occurrence Handle10.1111/j.1572-0241.2000.01701.x Occurrence Handle10638559 Occurrence Handle1:STN:280:DC%2BD3c7gt1SqtQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  14. 14

    NJ Bell D Burget CW Howden et al. (1992) ArticleTitleAppropriate acid suppression for the management of gastro-oesophageal reflux disease Digestion 51 IssueIDSuppl 1 59–67 Occurrence Handle1397746

    PubMed  Google Scholar 

  15. 15

    GN Tytgat (1987) ArticleTitleClinical efficacy of sucralfate in reflux esophagitis. Comparison with cimetidine Am J Med 83 IssueID3B 38–42 Occurrence Handle3661610 Occurrence Handle1:STN:280:DyaL1c%2FitFWitg%3D%3D

    PubMed  CAS  Google Scholar 

  16. 16

    N Chiba CJ Gara ParticleDe JM Wilkinson RH Hunt (1997) ArticleTitleSpeed of healing and symptom relief in grade II to IV gastroesophageal reflux disease: a meta-analysis Gastroenterology 112 IssueID6 1798–810 Occurrence Handle10.1053/gast.1997.v112.pm9178669 Occurrence Handle9178669 Occurrence Handle1:STN:280:DyaK2szit1Sitw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  17. 17

    DO Castell SA Brunton DL Earnest et al. (1998) ArticleTitleGERD: management algorithms for the primary care physician and the specialist Pract Gastroenterol 22 IssueID4 18–46

    Google Scholar 

  18. 18

    J Dent J Brun AM Fendrick et al. (1999) ArticleTitleAn evidence-based appraisal of reflux disease management – the Genval Workshop Report Gut 44 IssueIDSuppl 2 S1–S16

    Google Scholar 

  19. 19

    RH Hunt (1995) ArticleTitleThe relationship between the control of pH and healing and symptom relief in gastro-oesophageal reflux disease Aliment Pharmacol Ther 9 IssueIDSuppl 1 3–7 Occurrence Handle7495939

    PubMed  Google Scholar 

  20. 20

    KD Bardhan (1996) ArticleTitleDuodenal ulcer and gastroesophageal reflux disease today: long-term therapy – a sideways glance Yale J Biol Med 69 IssueID3 211–24 Occurrence Handle1:STN:280:DyaK2szgvVCltg%3D%3D

    CAS  Google Scholar 

  21. 21

    N Chiba (1997) ArticleTitleProton pump inhibitors in acute healing and maintenance of erosive or worse esophagitis: a systematic overview Can J Gastroenterol 11 IssueIDSuppl B 66B–73B Occurrence Handle9347181

    PubMed  Google Scholar 

  22. 22

    DA Johnson SB Benjamin NB Vakil et al. (2001) ArticleTitleEsomeprazole once daily for 6 months is effective therapy for maintaining healed erosive esophagitis and for controlling gastroesophageal reflux disease symptoms: a randomized, double-blind, placebo-controlled study of efficacy and safety Am J Gastroenterol 96 IssueID1 27–34 Occurrence Handle10.1111/j.1572-0241.2001.03443.x Occurrence Handle11197282 Occurrence Handle1:CAS:528:DC%2BD3MXhtFKjsro%3D

    Article  PubMed  CAS  Google Scholar 

  23. 23

    NB Vakil R Shaker DA Johnson et al. (2001) ArticleTitleThe new proton pump inhibitor esomeprazole is effective as a maintenance therapy in GERD patients with healed erosive oesophagitis: a 6-month, randomized, double-blind, placebo-controlled study of efficacy and safety Aliment Pharmacol Ther 15 927–35 Occurrence Handle11421866 Occurrence Handle1:CAS:528:DC%2BD3MXltFWqs7o%3D

    PubMed  CAS  Google Scholar 

  24. 24

    KR DeVault DO Castell (1995) ArticleTitleGuideliness for the diagnosis and treatment of gastroesophageal reflux disease Arch Intern Med 155 2165–73 Occurrence Handle10.1001/archinte.155.20.2165 Occurrence Handle7487238 Occurrence Handle1:STN:280:DyaK28%2FkvV2ltA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  25. 25

    KR DeVault DO Castell (1999) ArticleTitleUpdated guidelines for the diagnosis and treatment of gastroesphageal reflux disease Am J Gastroenterol 94 1434–42 Occurrence Handle10.1111/j.1572-0241.1999.1123_a.x Occurrence Handle10364004 Occurrence Handle1:STN:280:DyaK1M3ptVKksA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  26. 26

    NICE guideline. Dyspepsia: management of dyspepsia in adults in primary care. Available from: aspx?o=105765; February 2004

  27. 27

    P Katelaries R Holloway N Talley et al. (2002) ArticleTitleGastro-oesophageal reflux diease in adults: guidelines for clinicians J Gastroenterol Hepatol 17 825–33

    Google Scholar 

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Correspondence to Michael Pettit.

Additional information

* This Review article is accompanied by a Commentary on pp. 417–420.

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Pettit, M. Treatment of Gastroesophageal Reflux Disease*. Pharm World Sci 27, 432–435 (2005).

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  • Acid supression
  • Gastroesophageal reflux disease
  • Management
  • Therapy