Aims in the management of gastroesophageal reflux disease: a gastroenterologist’s viewpoint *

Abstract

Relieving heartburn and healing esophagitis may appear to be primary aims in the management of gastroesophageal reflux disease, but systematic consideration of the issues demonstrates that there are discrepancies between the fundamental aims of medical management and the aims selected for study in trials of drug efficacy. The initial aims of management are those concerned with diagnosis, patient assessment and the provision of explanation and advice. The therapeutic objectives are alleviating symptoms, preventing complications and, if possible, avoiding recurrence, and should ideally be judged in terms of health gain, including quality of life improvement. Obtaining value for money, by maximizing the health gain in relation to the cost of the overall medical intervention must also be acknowledged as a desirable aim of management, with the proviso that physicians must always treat each patient as an individual and individualize clinical management appropriately.

Diagnostisches und therapeutisches Management refluxassoziierter Erkrankungen des gastroösophagealen Übergangs

“…Konsens besteht in der Behandlung akuter säurebedingter retrosternaler Schmerzen mittels geeigneter medikamentöser Therapie. Die subjektiven Beschwerden, wie Sodbrennen und retrosternale Schmerzen, werden mittels einer medikamentösen Therapie mit Protonenpumpenhemmern suffizient reduziert [24]. Letztlich ist aber ein Langzeit- [38].…”

“…[23]. Nicht nur die Ausdehnung und der Umfang der refluxbedingten Schleimhautveränderungen, sondern auch die Ausbildung einer Barrett-Schleimhaut lassen sich in aller Regel bereits endoskopisch sichern [13,24]. In der endoskopischen Diagnostik des Barrett-Ösophagus lieûen sich die ursprünglichen, klassischen Diagnosekriterien [25], die auf einer willkürlich festgelegten Ausdehnungsgrenze zylinderzelliger Schleimhaut über das Niveau der Z-Linie hinaus beruhten [26], nicht mehr halten.…”

“Comparison of Nissen Rossetti and Floppy Nissen techniques in laparoscopic reflux surgery”

“…In recent years, developments in both medicine and surgery have led to an increase in discussions of the optimum treatment approach, especially between gastroenterologists and surgeons, and today the leading treatment method is considered to be PPI [ 5 , 6 ]. Indications for anti-reflux surgery should be based on the identification of the disease from objective values determined from appropriate tests and the presence of symptoms and should lead to the administration of an appropriate and effective medical treatment prior to surgery.…”