Long-Term Aims of Treatment of Reflux Disease, and the Role of Non-Drug Measures

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Abstract
Recent opinion about the long-term aims of treatment of reflux disease has been influenced substantially by the development of highly effective drugs that have minimal side-effects. The success of these drugs has emphasized the importance of gains in lifestyle resulting from relief of heartburn and other reflux-induced symptoms. Such relief is seldom achieved by traditional non-drug measures, which can also significantly impair lifestyle. In many patients with reflux disease, the effective relief of symptoms is a major aim. Oesophagitis, particularly when severe, carries a risk of developing peptic stricture or Barrett’s oesophagus, but the risk factors associated with the development of these significant complications are not well identified. There is also no direct evidence that successful healing of oesophagitis by drug therapy is associated with prevention of local complications of oesophagitis, although many anecdotes regarding the resolution of peptic stricture by successful anti-reflux surgery support this possibility. Similarly, the linkage between development of Barrett’s oesophagus and severe oesophagitis suggests that in some patients maintained healing of oesophagitis will prevent development or progression of Barrett’s oesophagus. These considerations support the aim of healing of severe oesophagitis (i.e. more than patchy erosions), quite independently of the need to achieve effective symptom relief.

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