Reflux Esophagitis

The various therapeutic approaches for reflux esophagitis are to increase the competence of the antireflux barrier, to enhance esophageal clearance, to improve gastric emptying and pyloric sphincter competence, to coat damaged tissue, and, especially, to reduce the volume and pH of gastric contents. Of the prokinetic agents, cisapride is the only drug with proven benefit. Single-agent therapy with conventional-dose H2-receptor antagonists or sucralfate results in similar degrees of symptom relief and healing. Post-evening meal (PEM) dosing of H2-receptor antagonists appears to be a rational method of suppressing late evening gastric acidity, but on balance the symptomatic response of twice daily dosing is superior to once daily dosing. More rapid symptom relief and healing are achieved with high-dose H2-receptor antagonists and omeprazole. The significance of sustained a(hypo)chlorhydria remains to be established. To prolong the symptomatic and/or endoscopic remission, the therapy has to be continued long-term with high-dose H2-receptor antagonist, cisapride either alone or in combination with H2-receptor antagonist, or sucralfate with or without H2-receptor antagonist. In the elderly or complicated patient long-term omeprazole may be a justifiable alternative.