Several studies have clearly demonstrated that
omeprazole is highly efficacious in the management of patients with
gastro-oesophageal reflux disease. In particular, wherever H2-receptor antagonists fail to produce results--in patients with severe disease--
omeprazole has been shown to be of major value. However, new alternatives are forthcoming; a new generation of more potent H2-receptor antagonists will be available, while 24 pH studies with high-dose
ranitidine have shown that
acid reflux is suppressed more efficiently than with standard doses. The prokinetic
drug cisapride appears to be of importance, not only in the management of patients with mild reflux disease, but also of cases with severe disease when
cisapride is combined with a H2-receptor antagonist. Such a combination could also be of value as an alternative to
omeprazole in long-term
therapy, since it has not yet been shown that indefinite treatment with
omeprazole of patients with reflux disease will be safe. In addition, the value of long-term
sucralfate, effective in short-term
therapy, needs to be evaluated in patients with chronic reflux disease who will not be operated. In forthcoming studies, it will be advisable to incorporate 24-hour pH measurements to detect periods of nonacid suppression more accurately. The future of medical management of
gastro-oesophageal reflux disease appears to be promising.