Gastroesophageal reflux disease. Current strategies for patient management
D. O. Castell and B. T. Johnston
Department of Internal Medicine, Graduate Hospital, Philadelphia, Pa, USA.
Gastroesophageal reflux disease is a chronic disease whose incidence is
often underestimated. Approximately 10% of the population in the United
States experience heartburn each day. In addition, as many as 50% of
patients with unexplained chest pain, chronic hoarseness, or asthma may be
suffering from gastroesophageal reflux disease. Disease severity ranges
from occasional, mild heartburn to erosive esophagitis and its
complications. Endoscopy and air-contrast barium radiography are important
diagnostic tools. Esophageal pH monitoring can confirm excessive reflux in
patients with atypical symptoms or in patients who do not respond to drug
therapy. Depending on severity, gastroesophageal reflux disease may be
managed through lifestyle modification, antacid and/or antirefluxant drugs,
promotility (prokinetic) drugs, fundoplication, and/or acid-suppressant
agents (eg, H2-receptor antagonists, proton pump inhibitors). Safety,
effectiveness, patient compliance, and cost factors must be considered in
determining the most appropriate long-term maintenance therapy.
