Gastroesophageal reflux disease.

Chronic GERD is an unremitting, incurable disorder that recurs rapidly upon discontinuation of therapy. Primary complications of GERD include esophagitis, esophageal stricture and Barrett esophagus. Current therapy focuses on modifying risk factors, inhibiting the production of acid and enhancing esophageal gastric motility. In patients with uncomplicated heartburn, nondrug therapy should be the initial therapeutic approach, with patient education a major step in promoting lifestyle changes and improving the outcome. Maintenance therapy is central to the management of GERD. If symptoms persist to suggest complicated disease, further diagnostic tests (endoscopy) are indicated. H2 receptor antagonists usually resolve symptoms in 50% to 70% of patients, and PPIs in 74% to 96% of patients. Agents that improve esophageal motility, such as cisapride, may provide symptomatic relief of heartburn, but healing effects are inconsistent. In refractory disease, therapy is individualized to the patient, and may include combination therapy, more aggressive single line therapy or an appropriate surgical approach.