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Medical management of gastroesophageal reflux disease in adults

INTRODUCTION

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".)

DEFINITIONS

Gastroesophageal reflux disease (GERD) is defined as a condition that develops when the reflux of stomach content causes troublesome symptoms and/or complications [3].

GERD is classified based on the appearance of the esophageal mucosa on upper endoscopy into the following:

Erosive esophagitis (EE) 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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Literature review current through: Jun 2014. | This topic last updated: Feb 26, 2014.
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