Management of Gastroesophageal Reflux Disease

C. Prakash Gyawali, Ronnie Fass

Research output: Contribution to journalArticle

48 Scopus citations

Abstract

Management of gastroesophageal reflux disease (GERD) commonly starts with an empiric trial of proton pump inhibitor (PPI) therapy and complementary lifestyle measures, for patients without alarm symptoms. Optimization of therapy (improving compliance and timing of PPI doses), or increasing PPI dosage to twice daily in select circumstances, can reduce persistent symptoms. Patients with continued symptoms can be evaluated with endoscopy and tests of esophageal physiology, to better determine their disease phenotype and optimize treatment. Laparoscopic fundoplication, magnetic sphincter augmentation, and endoscopic therapies can benefit patients with well-characterized GERD. Patients with functional diseases that overlap with or mimic GERD can be treated with neuromodulators (primarily antidepressants), or psychological interventions (psychotherapy, hypnotherapy, cognitive behavioral therapy). Future approaches to treatment of GERD include potassium-competitive acid blockers, reflux-reducing agents, bile acid binders, injection of inert substances into the esophagogastric junction, and electrical stimulation of the lower esophageal sphincter.

Original languageEnglish
Pages (from-to)302-318
Number of pages17
JournalGastroenterology
Volume154
Issue number2
DOIs
StatePublished - Jan 2018

Keywords

  • Antireflux Surgery
  • Gastroesophageal Reflux Disease
  • Histamine-2 Receptor Antagonist
  • Proton Pump Inhibitor

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