DYSPEPSIA MANAGEMENT Management of reflux disease

The management of reflux disease can be divided into three major phases, the first being diagnosis and severity assessment, the second, prompt initial control of symptoms, and the third, selection of a long term management approach that is tailored to meet individual patient needs and preferences. Throughout these phases of management, the major priorities should include achieving patient satisfaction and minimising management costs. SUMMARY The management of reflux disease can be divided into three major phases: initial diagnosis/severity assessment, subsequent symptom control with diagnostic confirmation, and finally, a long term care plan tailored to individual patient character-istics. The now substantial experience from clini-cal studies in the full spectrum of patients with reflux disease underlines the primary importance of symptom assessment for diagnosis as the majority of patients have a distinctive symptom pattern. Endoscopy is a poor substitute for symp-tom assessment as in approximately 60 % of reflux disease patients clearcut oesophagitis is absent. Symptom control, and thus diagnostic confirma-tion, is achieved most reliably with proton pump inhibitor (PPI) therapy so that initial therapy with one of these agents is an attractive option compared with initial therapy with less predict-ably effective agents. Long term care needs to provide effective medical or surgical control of reflux disease. In endoscopy negative patients, or those with only mild oesophagitis, intermittent courses of therapy or day to day symptom driven use of medication as needed, frequently succeed, with substantial reduction of the costs of medi-cation. The choice between antireflux surgery and medical therapy in patients whose disease re-quires daily medication should be governed by informed patient preference and the quality of antireflux surgery available