Gastro-oesophageal reflux disease--current concepts in management.
BACKGROUND
Gastro-oesophageal reflux disease (GORD) is defined as recurring symptoms or mucosal damage resulting from exposure of the distal oesophagus to reflux of gastric contents. In the past, GORD has been managed with a 'step up' approach beginning with antacids and progressing to H2 antagonists or proton pump inhibitors (PPI) as required.


OBJECTIVE
This article presents a systematic approach to the management of GORD.


CONCLUSIONS
Diagnosis of GORD is made on the basis of symptoms and the decision to treat is based on the symptom pattern. Endoscopy is reserved for cases where there are alarm symptoms, diagnostic uncertainty, poor response to treatment or clinical suspicion of a complication such as Barrett's oesophagus or stricture. A 'step down' approach to treatment involves treating with a PPI for 4-8 weeks. Aggressive therapy is then reduced to maintenance doses, intermittent therapy or in some cases, withdrawn. However, relapse occurs in about 70% of all patients within 6 months. A step down approach ensures more rapid resolution of symptoms, improved quality of life, reduced risk of complications, and overall lower cost.
Piterman
Leon
L
Monash University Department of General Practice, Melbourne, Victoria. leon.piteman@med.monash.edu.au
Nelson
Mark
M
Dent
John
J
D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001471:Barrett Esophagus / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D002985:Clinical Protocols; D005194:Family Practice / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans
D000897:Anti-Ulcer Agents