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Clinical Review Fortnightly review

Treatment of gastro-oesophageal reflux disease in adults

BMJ 1998; 316 doi: (Published 06 June 1998) Cite this as: BMJ 1998;316:1720
  1. Jean Paul Galmiche (, professor of gastroenterology,
  2. Eric Letessierb, assistant professor of surgery,
  3. Carmelo Scarpignatoc, professor of phrmacology
  1. a Department of Gastroenterology and Hepatology, Hotel-Dieu University Hospital, 44035 Nantes Cedex 01, France
  2. b Gastrosurgical Unit, College of Medicine, University of Nantes, France
  3. c Institute of Pharmacology, School of Medicine and Dentistry, University of Parma, Italy
  1. Correspondence to: Professor Galmiche

    Gastro-oesophageal reflux disease is caused by retrograde flow of gastric contents through an incompetent gastro-oesophageal junction. The disease encompasses a broad spectrum of clinical disorders from heartburn without oesophagitis to severe complications such as strictures, deep ulcers, and intestinal metaplasia (Barrett's oesophagus).1 The prevalence of heartburn, the most typical symptom of gastro-oesophageal reflux disease, is extremely high,2 but most people with reflux do not seek medical help for this condition and treat themselves with over the counter preparations. Oesophagitis (defined by mucosal breaks) is less frequent, occurring in less than half of patients undergoing endoscopy for reflux symptoms. Symptoms and severity of oesophagitis are poorly correlated. Although reflux may remain silent in patients with Barrett's oesophagus, heartburn can severely affect the quality of life of patients with negative endoscopy results. The natural course of the disease also varies considerably.2 Patients with gastro-oesophageal reflux disease seen by gastroenterologists usually have a chronic condition with frequent relapses, whereas those who rely on general practitioners' help usually have less severe disease, consisting of intermittent attacks with prolonged periods of remission.

    Summary points

    Most patients with dominant heartburn have no signs of oesophagitis at endoscopy. However, chronic relapsing gastro-oesophageal reflux disease can severely affect quality of life

    In primary care many patients can be successfully treated by intermittent courses of drugs on demand

    Alginate-antacids and H2 receptor antagonists are useful in patients with mild disease

    Cisapride is as effective as H2 receptor antagonists in short term treatment and can prevent relapse in mild oesophagitis

    Proton pump inhibitors relieve symptoms and heal oesophagitis more completely and faster than other drugs. They are effective throughout the disease spectrum, and maintenance therapy prevents recurrences

    The principles of laparoscopic and open antireflux surgery are the same. In skilled hands, similarly good results have been reported …

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