In the treatment of
gastroesophageal reflux disease (
GERD), the most effective treatment option is the use of
proton pump inhibitor (PPI), which minimizes the effect of gastric acid on the distal esophagus. Both the step-up and step-down treatment strategies have advantages and disadvantages. Most physicians would like to choose the step-down
therapy rather than the step-up
therapy. The 'No-step' PPI
therapy (i.e. continuous PPI
therapy) is another relevant option. After an initial remission, long-term PPI
therapy is an appropriate form of maintenance
therapy in many patients. As a treatment plan for
non-erosive reflux disease, a standard dose of PPI for 4-8 weeks followed by either the step-down strategy or the on-demand treatment strategy is acceptable. When treating erosive
esophagitis, PPI is better than H(2) receptor blockers in healing mucosal breaks and relieving symptoms. Long-term maintenance PPI
therapy is reported to be very effective in maintaining the remission of
reflux esophagitis for up to 5 years. On-demand PPI is also another good option for a maintenance
therapy in erosive
esophagitis. In
Barrett's esophagus, symptoms seem to be well-controlled with PPIs. Unfortunately, however, PPIs have no effect on the shortening of
Barrett's esophagus or in preventing the progression to dysplasia and
adenocarcinoma. In summary, after reviewing existing guidelines a rather simple guideline on the management of
GERD is suggested - PPI should be given for 4-8 weeks followed by either on-demand or maintenance PPI
therapy according to the clinical severity.