Long-term Management of Gerd: Proton Pump Inhibitors versus Newer Endoscopic Interventions versus Surgery*

Gastroesophageal reflux disease (GERD) affects approximately 20% of the US population and is one of the most common acid-related disorders in US adults. One of the key symptoms of this often chronic disorder is heartburn. Gastroesophageal reflux disease is known to cause heartburn, and the presence of acid in the esophagus for prolonged periods is now known to place patients at risk for serious sequelae, such as Barrett’s esophagus and esophageal cancer. Therefore, long-term management options are needed, including lifestyle changes, pharmacological therapy, surgery, and endoscopic intervention. Proton pump inhibitors have been found to be superior to other medications both in inducing symptom resolution and healing esophagitis. The outcomes reported from surgical and endoscopic treatments are mixed. Recent data suggest that approximately one fourth of surgically treated patients will require continued antisecretory therapy for persistent GERD symptoms postoperation. Though a number of endoscopic procedures have been approved for use in the United States, their effectiveness and their roles in clinical practice remain controversial. (Adv Stud Med. 2003;3(3A):S123-S127) T he major treatment options, other than lifestyle changes, for the long-term care of adult gastroesophageal reflux disease (GERD) patients are medical therapy, surgery, and newer endoscopic procedures. This article will review evidence surrounding each of these treatment options and guide the clinician in choosing appropriate management plans for patients’ heartburn relief, healing of erosive esophagitis, and maintenance of clinical remission.