Management of reflux disease

Abstract

The management of reflux disease can be divided into three major phases, the first being diagnosis and severity assessment, the second, prompt initial control of symptoms, and the third, selection of a long term management approach that is tailored to meet individual patient needs and preferences. Throughout these phases of management, the major priorities should include achieving patient satisfaction and minimising management costs.

Figure 1

Schema for the initial management of patients with typical reflux induced symptoms. Adapted from Dent and colleagues,² with permission.

Figure 2

Simplified schema for the management of patients with Los Angeles grade C or D (severe) oesophagitis. PPI, proton pump inhibitor.

Figure 3

Initial management plan for patients other than those known to have severe oesophagitis. Adapted from Dent and colleagues,² with permission. H₂RA, H₂ receptor antagonist; PPI, proton pump inhibitor.

Figure 4

Mainstream options for the step down of daily long term medical therapy. H₂RA, H₂ receptor antagonist; PPI, proton pump inhibitor. *No clear dose-response established.

Figure 5

Management pathways subsequent to initial management (see fig 3) in patients other than those known to have severe oesophagitis. Adapted from Dent and colleagues,² with permission.

Figure 6

Variations in the rate of relapse from three different studies in untreated or placebo treated patients over six or 12 months, after withdrawal of successful initial acid suppression therapy. Data from Carlsson and colleagues,¹⁶ Blum and colleagues,¹⁷ and Bardhan and colleagues.¹⁸