Therapeutic Approaches to Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a common disorder. It often occurs concurrently with other disorders and can be a concomitant of medications used in the management of pain and other symptoms. Patients with GERD present with a broad spectrum of symptoms ranging from mild intermittent episodes of heart-burn to severe, bleeding esophageal erosions and ulcers. Lifestyle modifications serve as the cornerstone to initial medical therapy. Pharmacological options include antacids, alginic acid, sucralfate, histamine-2 (H2) receptor antagonists, proton pump inhibitors, and prokinetic agents. Relief of mild GERD symptoms can be achieved with antacids, or over-the-counter H2 receptor antagonists. Patients with moderate to severe disease require sustained inhibition of gastric acid secretion to control symptoms, heal the esophagus, and prevent complications. Preventing symptomatic recurrence and maintaining remission increases quality of life and decreases overall costs associated with the disease. This paper reviews the etiology, pathogenesis, clinical presentation, and medical management of GERD. Emphasis is placed on the comparative efficacy and safety of pharmacotherapy and recommendations are made with regard to treatment strategies and the cost-effectiveness of therapeutic regimens.