How is reflux esophagitis treated?

Updated: May 02, 2019
  • Author: Deepika Devuni, MBBS; Chief Editor: BS Anand, MD  more...
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Answer

Previously, histamine-2 receptor antagonist (H2RA) therapy was recommended as the initial treatment for esophagitis associated with gastroesophageal reflux disease (GERD); however, subsequent studies of cost-effectiveness and symptomatic relief suggested that proton pump inhibitors (PPIs) (eg, omeprazole 20 mg/day, pantoprazole 40 mg/day, or lansoprazole 30 mg/day for 4-8 weeks) are superior to ranitidine, cimetidine, and placebo.

The 2013 GERD guidelines from the American College of Gastroenterology (ACG) emphasize that PPIs are more effective than H2RAs for GERD on the basis of the highest-level evidence. [49] No significant differences among the various PPIs currently available were noted.

Cisapride, a gastroprokinetic agent, and sucralfate, a coating agent, are less effective but may be useful in selected patients or as second-line agents. Cisapride is only available through an investigational limited-access program because of its potential for risk of serious cardiac arrhythmias and death.

Some authorities recommend PPIs and H2RAs for patients with ulcerlike-dominant symptoms (eg, nocturnal symptoms, relief with food) and gastroprokinetic agents for patients with dysmotility dominant symptoms (eg, nausea, bloating).

Although no consensus on treatment choice exists, prescribing for 2-4 weeks with reassessment is reasonable. Some patients with relapse may require long-term maintenance therapy.

According to the 2013 ACG guidelines, GERD patients whose symptoms continue after discontinuance of PPI therapy and those with complications such as erosive esophagitis and Barrett esophagus are likely to require long-term, even life-long, maintenance therapy. [49] For patients who require long-term PPI therapy, it should be administered at the lowest effective dose, including on-demand or intermittent therapy.


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