Medical management of patients with esophageal or supraesophageal gastroesophageal reflux disease.

With the common use of proton pump inhibitors (PPIs), the medical treatment of gastroesophageal reflux disease (GERD) and its complications is now successful in relieving symptoms, healing esophagitis, and preventing complications. Physiologic factors that may contribute to a poor response to these drugs include the considerable variation in the bioavailability of PPIs, the need to take PPIs with meals, the influence of Helicobacter pylori-associated gastritis, and genetic variation in enzyme capacity, resulting in rapid and slow metabolizers of PPIs. Subsets of reflux patients, such as the elderly, pregnant women, and those with supraesophageal symptoms or Barrett esophagus, may have special treatment requirements. Medical treatment of GERD with PPIs has been demonstrated to equal the success of antireflux surgery in short- and long-term follow-up with reasonably few side effects. Furthermore, a good response to PPI therapy predicts a successful outcome with antireflux surgery.