[Gastroesophageal reflux: current status of therapy].

Abstract

The aim in treatment of reflux oesophagitis is to relieve symptoms as well as to prevent complications and recurrence of the disease. The obvious preventive measures as abstinence from alcohol and nicotine and to sleep in a raised bed are useful for the health of the patient in general, but application on a whole is not possible and their efficiency in therapy of reflux oesophagitis is questionable. As to pharmaceutical treatment, proton pump inhibitors are the first line therapy. Such treatment enables the raising of pH levels over 4 to enable efficient acid blocking. It works directly on the key enzyme without being influenced by other environmental factors. Proton pump inhibitors have few side effects and they are suitable for long term treatment. In comparison to other medications proton pump inhibitors have proved to be significantly better in reducing symptoms of reflux oesophagitis in a shorter time. They also reduce healing time of peptic lesions and have proved to be efficient in higher stages of reflux oesophagitis and even in cases resistant to H2-inhibitors. H2-inhibitors have lost their place in the treatment of reflux oesophagitis with the arrival of proton pump inhibitors, because they are less effective, have a comparable number of side effects and are not prophylactic against relapse. Only patients complaining of reflux symptoms without provable morphological changes in the oesophago-gastral region are suitable for treatment with antacida or H2-inhibitors. There is a strict indication for long term treatment in stages with severe morphological changes (stage III or IV according to Savary and Miller) and in prevention of symptomatical relapse.(ABSTRACT TRUNCATED AT 250 WORDS)