Management of Gastroesophageal Reflux Disease

Gastroenterology. 2018 Jan;154(2):302-318. doi: 10.1053/j.gastro.2017.07.049. Epub 2017 Aug 5.


Management of gastroesophageal reflux disease (GERD) commonly starts with an empiric trial of proton pump inhibitor (PPI) therapy and complementary lifestyle measures, for patients without alarm symptoms. Optimization of therapy (improving compliance and timing of PPI doses), or increasing PPI dosage to twice daily in select circumstances, can reduce persistent symptoms. Patients with continued symptoms can be evaluated with endoscopy and tests of esophageal physiology, to better determine their disease phenotype and optimize treatment. Laparoscopic fundoplication, magnetic sphincter augmentation, and endoscopic therapies can benefit patients with well-characterized GERD. Patients with functional diseases that overlap with or mimic GERD can also be treated with neuromodulators (primarily antidepressants), or psychological interventions (psychotherapy, hypnotherapy, cognitive and behavioral therapy). Future approaches to treatment of GERD include potassium-competitive acid blockers, reflux-reducing agents, bile acid binders, injection of inert substances into the esophagogastric junction, and electrical stimulation of the lower esophageal sphincter.

Keywords: Antireflux Surgery; Gastroesophageal Reflux Disease; Histamine-2 Receptor Antagonist; Proton Pump Inhibitor.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antacids / therapeutic use
  • Biopsy
  • Cost of Illness
  • Drug Resistance
  • Electric Stimulation Therapy / methods
  • Eosinophilic Esophagitis / diagnosis
  • Eosinophilic Esophagitis / pathology
  • Esophageal Sphincter, Lower / innervation
  • Esophageal Sphincter, Lower / pathology
  • Esophageal Sphincter, Lower / physiopathology
  • Esophageal Sphincter, Lower / surgery
  • Esophageal pH Monitoring
  • Esophagoscopy / methods*
  • Fundoplication / methods*
  • Gastric Bypass
  • Gastroesophageal Reflux / diagnosis
  • Gastroesophageal Reflux / economics
  • Gastroesophageal Reflux / epidemiology
  • Gastroesophageal Reflux / therapy*
  • Histamine H2 Antagonists / therapeutic use
  • Humans
  • Laparoscopy / methods*
  • Neurotransmitter Agents / therapeutic use
  • Prevalence
  • Proton Pump Inhibitors / economics
  • Proton Pump Inhibitors / pharmacology
  • Proton Pump Inhibitors / therapeutic use*
  • Risk Reduction Behavior
  • Treatment Outcome


  • Antacids
  • Histamine H2 Antagonists
  • Neurotransmitter Agents
  • Proton Pump Inhibitors