Acid reflux is a chronic condition with regular relapses in many patients. The problem is directly related to the lower esophageal sphincter. When the LES becomes incompetent, no medical treatment will rectify this. Acid reflux treatment is to reduce the acid level in the gastric contents refluxing back up into the esophagus. This means that the reflux will continue but the refluxate, being less acidic, is unlikely to injure the esophagus.

The lining of the esophagus does not cope with high acid levels as well as the gastric lining. Persistent high acid levels in the esophagus will result in symptoms such as heartburn and complication such as strictures, bleeding and Barrett’s esophagus. In some acid reflux patients the problems gets progressively worse.

However, when the esophageal mucosa becomes eroded by the persistent assault from gastric acid, erosions can develop. Erosions can lead to complications. Non-erosive acid reflux can be easy to treat but erosive esophagitis needs continuous acid reflux treatment. This acid reflux treatment is in the form of acid reflux suppression by drugs such as proton pump inhibitors i.e. lansaprazole and omeprazole.

Trials have shown that continuous acid reflux treatment with proton pump inhibitors effectively maintain symptom remission and absence of esophageal erosion.

The impression is that by removing esophageal erosion from the overall picture, the development of complications will not occur. This, however, has not yet been demonstrated.

Of concern to patients with GERD is that long term acid reflux treatment with H2-receptor antagonists and proton pump inhibitors may lead to other problems. These drugs are extensively used globally and so far the impression is that they are safe long term acid reflux treatment.

Dr. Phil Hariram