Medical management of gastroesophageal reflux disease in adults
- Peter J Kahrilas, MD
Peter J Kahrilas, MD
- Professor of Medicine
- Feinberg School of Medicine, Northwestern University
The passage of gastric contents into the esophagus (gastroesophageal reflux) is a normal physiologic process. Most episodes are brief and do not cause symptoms, esophageal injury, or other complications. Gastroesophageal reflux becomes a disease when it either causes macroscopic damage to the esophagus or causes symptoms that reduce the quality of life.
This topic will review the initial management of gastroesophageal reflux disease (GERD) and maintenance therapy for patients with recurrent GERD when treatment is discontinued. Our recommendations are largely consistent with the American Gastroenterological Association and the American College of Gastroenterology guidelines [1,2]. The evaluation and management of refractory GERD and the role of surgery and endoscopic therapy in patients with GERD are discussed separately. (See "Approach to refractory gastroesophageal reflux disease in adults" and "Surgical management of gastroesophageal reflux in adults" and "Radiofrequency treatment for gastroesophageal reflux disease".)
Gastroesophageal reflux disease (GERD) is defined as a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications .
GERD is classified based on the appearance of the esophageal mucosa on upper endoscopy into the following:
●Erosive esophagitis is characterized by endoscopically visible breaks in the distal esophageal mucosa with or without troublesome symptoms of GERD. (See "Clinical manifestations and diagnosis of gastroesophageal reflux in adults", section on 'Esophagitis on esophagoscopy'.)
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- INDICATIONS FOR UPPER ENDOSCOPY
- INITIAL THERAPY
- Mild and intermittent symptoms
- - Lifestyle and dietary modification
- - Antacids
- - Surface agents and alginates
- - Histamine 2 receptor antagonists
- Severe or frequent symptoms or erosive esophagitis
- - Proton pump inhibitors
- - Treatment of Helicobacter pylori infection
- REFRACTORY SYMPTOMS
- MANAGEMENT OF RECURRENT SYMPTOMS AND MAINTENANCE THERAPY
- PREGNANCY AND LACTATION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS