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Management strategies for gastroesophageal reflux disease.
J Gastroenterol Hepatol. 2004 Sep; 19 Suppl 3:S49-53.JG

Abstract

In the treatment of gastroesophageal reflux disease (GERD), the most effective treatment option is the use of proton pump inhibitor (PPI), which minimizes the effect of gastric acid on the distal esophagus. Both the step-up and step-down treatment strategies have advantages and disadvantages. Most physicians would like to choose the step-down therapy rather than the step-up therapy. The 'No-step' PPI therapy (i.e. continuous PPI therapy) is another relevant option. After an initial remission, long-term PPI therapy is an appropriate form of maintenance therapy in many patients. As a treatment plan for non-erosive reflux disease, a standard dose of PPI for 4-8 weeks followed by either the step-down strategy or the on-demand treatment strategy is acceptable. When treating erosive esophagitis, PPI is better than H(2) receptor blockers in healing mucosal breaks and relieving symptoms. Long-term maintenance PPI therapy is reported to be very effective in maintaining the remission of reflux esophagitis for up to 5 years. On-demand PPI is also another good option for a maintenance therapy in erosive esophagitis. In Barrett's esophagus, symptoms seem to be well-controlled with PPIs. Unfortunately, however, PPIs have no effect on the shortening of Barrett's esophagus or in preventing the progression to dysplasia and adenocarcinoma. In summary, after reviewing existing guidelines a rather simple guideline on the management of GERD is suggested - PPI should be given for 4-8 weeks followed by either on-demand or maintenance PPI therapy according to the clinical severity.

Authors+Show Affiliations

Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea. drbakyt@korea.ac.kr

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

15324382

Citation

Bak, Young-Tae. "Management Strategies for Gastroesophageal Reflux Disease." Journal of Gastroenterology and Hepatology, vol. 19 Suppl 3, 2004, pp. S49-53.
Bak YT. Management strategies for gastroesophageal reflux disease. J Gastroenterol Hepatol. 2004;19 Suppl 3:S49-53.
Bak, Y. T. (2004). Management strategies for gastroesophageal reflux disease. Journal of Gastroenterology and Hepatology, 19 Suppl 3, S49-53.
Bak YT. Management Strategies for Gastroesophageal Reflux Disease. J Gastroenterol Hepatol. 2004;19 Suppl 3:S49-53. PubMed PMID: 15324382.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management strategies for gastroesophageal reflux disease. A1 - Bak,Young-Tae, PY - 2004/8/25/pubmed PY - 2004/12/22/medline PY - 2004/8/25/entrez SP - S49 EP - 53 JF - Journal of gastroenterology and hepatology JO - J. Gastroenterol. Hepatol. VL - 19 Suppl 3 N2 - In the treatment of gastroesophageal reflux disease (GERD), the most effective treatment option is the use of proton pump inhibitor (PPI), which minimizes the effect of gastric acid on the distal esophagus. Both the step-up and step-down treatment strategies have advantages and disadvantages. Most physicians would like to choose the step-down therapy rather than the step-up therapy. The 'No-step' PPI therapy (i.e. continuous PPI therapy) is another relevant option. After an initial remission, long-term PPI therapy is an appropriate form of maintenance therapy in many patients. As a treatment plan for non-erosive reflux disease, a standard dose of PPI for 4-8 weeks followed by either the step-down strategy or the on-demand treatment strategy is acceptable. When treating erosive esophagitis, PPI is better than H(2) receptor blockers in healing mucosal breaks and relieving symptoms. Long-term maintenance PPI therapy is reported to be very effective in maintaining the remission of reflux esophagitis for up to 5 years. On-demand PPI is also another good option for a maintenance therapy in erosive esophagitis. In Barrett's esophagus, symptoms seem to be well-controlled with PPIs. Unfortunately, however, PPIs have no effect on the shortening of Barrett's esophagus or in preventing the progression to dysplasia and adenocarcinoma. In summary, after reviewing existing guidelines a rather simple guideline on the management of GERD is suggested - PPI should be given for 4-8 weeks followed by either on-demand or maintenance PPI therapy according to the clinical severity. SN - 0815-9319 UR - https://www.unboundmedicine.com/medline/citation/15324382/Management_strategies_for_gastroesophageal_reflux_disease_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0815-9319&date=2004&volume=19&issue=&spage=S49 DB - PRIME DP - Unbound Medicine ER -