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Lee J Hixson, MD; Catherine L. Kelley, PharmD; William N. Jones, MS; Craig D. Tuohy, MD

Arch Intern Med. 1992;152(4):717-723.

Abstract
Medical therapy for gastroesophageal reflux disease should entail a multistep approach. After life-style changes, many patients will require histamine² receptor antagonists in conventional doses with repeated therapeutic courses, if not continuous maintenance. Prokinetic agents are potentially useful in those patients with impaired motor function of the esophageal or gastric smooth muscle. Combination therapy with histamine2 receptor antagonists and prokinetic agents or sucralfate provides modest healing benefit, if any, over that by histamine, receptor antagonists alone. For patients with more severe refractory disease, omeprazole has provided unequaled healing rates and accelerated symptomatic relief. High-dose (twofold or more standard dose) histamine2 receptor antagonist therapy may also heal highgrade esophagitis, but the reported experience is small. After healing is achieved, an attempt should generally be made to "step down" therapy to standard-dose histamine² receptor antagonist as maintenance. Finding the least amount of drug to control symptoms and maintain the integrity of the esophageal mucosa would minimize cost and potential long-term risk.

(Arch Intern Med. 1992;152:717-723)

Author Affiliations
From the Medical (Drs Hixson and Touhy) and Pharmacy (Dr Kelley and Mr Jones) Services, Veterans Affairs Medical Center and Colleges of Medicine and Pharmacy, University of Arizona (Tucson).

Footnotes
Accepted for publication August 27, 1991.

Reprint requests to University Medical Center, GI Section, Room 6406, 1501 N Campbell Ave, Tucson, AZ 85724 (Dr Hixson).

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