Acid Suppression Therapyfor GERD:The Devil's in the Details, Part II

摘要

For most patients, GERD is a chronic relapsing problem. Hence, long-term maintenance treatment with antisecretory therapy is crucial to assure quality of life and longer asymptomatic periods. Once the patient's symptoms are well controlled with initial antisecretory therapy, often with a PPI, two pharmacological options are suited for maintenance therapy: 1. A step-wise reduction in treatment intensity down the hierarchy and attempted discontinuation of medications with continued lifestyle modifications. The decision to step-down should be individualized and takes into consideration the patient's prefer-ence, their clinical status, the likelihood of complications, previous response to treatment, the likelihood of follow-up and overall costs. Many patients have episodic disease that recurs infrequently or not at all. This approach allows identifying these patients and avoiding unnecessary long-term prescription drug treatment. "On demand" therapy may be a reasonable approach in those with infrequent symptoms and mild esophagitis. Indeed, many GERD patients who are prescribed long-term medication only take it as needed, apparently content to experience some continuing symptoms (1). Differentiating patients who benefit from "on demand" use from those who require long-term antisecretory therapy is important. Should symptoms recur, after step down or discontinued therapy restart the initial effective regimen. Any patient who requires continuous maintenance medical therapy should undergo endoscopy at least once to rule out Barrett's esophagus.