Drug therapy of gastro-oesphageal reflux

Gastro-oesphageal reflux disease (GORD) occurs due to the inappropriate relaxation of the lower oesophageal sphincter. This permits the contents of the stomach to pass into the oesphagus. Reflux may lead to oesphagitis which while disrupting oesphageal motility, can reduce sphincter tone further, thus leading to a worsening of reflux.

Depending upon the severity of symptoms, the presence of complications and any associated illness, the active drug treatment of GORD generally begins after milk thickening agents and feeding advice have failed.

Pro-kinetic agents increase the oesphageal sphincter pressure and promote gastric emptying. In general, cisapride is used first line with domperidone introduced if this does not work as monotherapy.

H2 antagonists or proton pump inhibitors are sometimes introduced to patients who have severe disease in order to reduce gastric acid secretion.