GASTROESOPHAGEAL REFLUX DISEASE - THERAPY AND CONSEQUENCES

In approximately 10-15% of patients with symptoms of gastroesophageal reflux, endoscopic investigation will reveal the presence of reflux esophagitis. Once this diagnosis has been made, treatment should be given as esophagitis may lead to serious complications such as bleeding, ulceration and development of a columnar-lined or Barrett's esophagus. Mainstay of treatment are conservative measures and adjustment of life style. In the revalidation phase of their disease patients with esophagitis should be instructed how to change their life style and the results should be evaluated. In case of severe esophagitis medical treatment will be necessary in addition to these basic measures. After healing, long-term treatment, usually with acid inhibitory drugs (H2-receptor antagonists or omeprazol) is necessary to prevent relapse of inflammation and complications. So far long-term treatment has been shown to be safe and effective. In case of antireflux surgery, investigation of esophageal motility and 24-pH measurement should be performed preoperatively. In case of Barrett's esophagus-long term surveillance is mandatory as dysplasia and adenocarcinoma may develop.