Recent advances in the management of gastro-oesophageal reflux disease.

The basis of treatment of reflux oesophagitis is change in behaviour and lifestyle. In the presence of mild symptoms antacids/alginate may be instituted. In case of Savary grade I and II oesophagitis at endoscopy, H2-receptor antagonists (H2RAs), alone or in combination with a prokinetic or mucosaprotective agent, are the first choice of treatment. Drug treatment should be continued for at least 8-12 weeks. In case of resistance to treatment or in case of severe and/or complicated reflux oesophagitis, omeprazole should be prescribed. Maintenance treatment is necessary in patients with severe reflux oesophagitis and in patients with quick relapses, once therapy has stopped. Full-dose H2RAs are required to prevent recurrences. In case of resistance to H2RAs, omeprazole should be used. Anti-reflux surgery should be considered in patients, especially at young age, who have an insufficient response to medical management, due either to lack of compliance or to therapeutic failure.