Management of gastroesophageal reflux disease in adults

Gastroesophageal reflux disease (GERD) is a very common disease. GERD is defined as the re- flux of stomach content which causes troublesome symptoms and/or complications. The management of GERD is step by step. Dietary and lifestyle modifications are the first steps. Twice-daily H2RAs at stan- dard doses for a minimum duration of two weeks can be considered in patients with GERD who fail to respond to lifestyle and dietary modifications. If symptoms of GERD persist, once-daily Proton Pump Inhibitors (PPIs) can be recommended. Patients with an unsatisfactory response to once-daily PPIs dos- ing can be considered to have refractory GERD. Twice-daily PPI therapy can be recommended in pa- tients who fail to respond to once-daily PPI therapy. The add-on treatment with H2RAs, baclofen, or visceral pain modulators can be considered in selective subjects with GERD who fail to respond to twice- daily PPI. Anti-reflux surgery may be taken into account in selected patients. This review focuses on the initial and maintenance therapy of GERD and also reviews different management of recurrent and