Treatment of Gastro-Oesophageal Reflux Disease

The most used and preferred medications are proton pump inhibitors (PPIs), such as omeprazole, lansoprazole, rabeprazole and esomeprazole. These reduce the production of stomach acid and the harmful capacity of gastric material that can reflux into the oesophagus. The idea is for these drugs to be taken daily for a period of time, then intermittently after symptoms have improved or resolved.

Other antisecretory drugs, such as histamine receptor antagonists (e.g., famotidine and ranitidine). These are less effective than PPIs, but can be used in mild cases or as an alternative to PPIs in specific cases. Prokinetic drugs (e.g., domperidone, metoclopramide and erythromycin) that promote gastric emptying can also be used. These are indicated in patients with a predominance of regurgitation symptoms and delay in this emptying.

There are many endoscopic treatments, but there is still not enough scientific evidence to recommend them generally. In the specific case of patients who have a decrease in the diameter of the oesophagus (peptic stenosis), endoscopic dilations can be performed to improve GORD.

Fundoplication is a surgical procedure used to treat gastro-oesophageal reflux. In this procedure, the upper part of the stomach, called the fundus, is folded and sewn around the muscular valve at the bottom of the oesophagus (lower oesophageal sphincter). This increases the pressure of the lower oesophageal sphincter and prevents acid from flowing back into the oesophagus.

It has a similar effectiveness to medical treatment, in relation to symptom control, the healing of oesophagitis and on quality of life. This treatment is recommended in patients with:

• Good symptomatic response to medical treatment who prefer surgery to chronic treatment or who are intolerant to it.
• Persistent symptoms due to regurgitation, especially if respiratory complications occur.
• Repeated decrease in the diameter of the oesophagus (oesophageal peptic strictures) in young people.