Gastroesophageal reflux disease. Current strategies for patient management.

Gastroesophageal reflux disease is a chronic disease whose incidence is often underestimated. Approximately 10% of the population in the United States experience heartburn each day. In addition, as many as 50% of patients with unexplained chest pain, chronic hoarseness, or asthma may be suffering from gastroesophageal reflux disease. Disease severity ranges from occasional, mild heartburn to erosive esophagitis and its complications. Endoscopy and air-contrast barium radiography are important diagnostic tools. Esophageal pH monitoring can confirm excessive reflux in patients with atypical symptoms or in patients who do not respond to drug therapy. Depending on severity, gastroesophageal reflux disease may be managed through lifestyle modification, antacid and/or antirefluxant drugs, promotility (prokinetic) drugs, fundoplication, and/or acid-suppressant agents (eg, H2-receptor antagonists, proton pump inhibitors). Safety, effectiveness, patient compliance, and cost factors must be considered in determining the most appropriate long-term maintenance therapy.