Pharmacologic strategies for treating gastroesophageal reflux disease.
OBJECTIVE
This paper presents a synopsis of the pathophysiology of gastroesophageal reflux disease (GERD) and the efficacy, safety, and cost of the agents commonly used in its treatment.


BACKGROUND
Symptomatic relief of GERD can be obtained with lifestyle changes (avoidance of factors that may exacerbate symptoms, such as overeating and use of alcohol and tobacco) and use of over-the-counter medications such as antacids or histamine-2 (H2)-receptor antagonists. When these measures are unsuccessful, treatment with prescription-strength medications is required to prevent complications, such as Barrett's esophagus or esophageal adenocarcinoma.


METHODS
Current guidelines for the management of GERD were identified through a MEDLINE search of the English-language literature from January 1995 through December 1999 and a search of the bibliographies of identified articles.


CONCLUSIONS
Patients who do not respond to initial therapy should be managed with prescription-strength H2-receptor antagonists. Endoscopy should be considered for patients with atypical or refractory symptoms. Patients with a confirmed diagnosis of refractory GERD, severe esophagitis, Barrett's esophagus, or peptic stricture should be treated with and maintained on a proton-pump inhibitor.
Vivian
E M
EM
Department of Pharmacy Practice and Administration, Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Pennsylvania 19104-4495, USA.
Thompson
M A
MA
D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000191:economics; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D017410:Practice Guidelines as Topic
D006635:Histamine H2 Antagonists