CLINICAL TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE: WHAT DO THE LATEST STUDIES AVOID? (Atena Editora)

Abstract

INTRODUCTION: Gastroesophageal reflux is a physiological response of the body. When, for any reason, this reflux is associated with diseases, complications and impairment of quality of life, the condition is called gastroesophageal reflux disease (GERD). The clinical diagnosis of GERD is very sensitive, as most patients have the classic symptoms of the disease. The treatment can be clinical or surgical, depending on its dominant form of presentation and its main etiology. Surgery will rarely be a first option, as it must be reserved for cases that are refractory to medical treatment or for life-threatening situations. For this reason, the current discussion aims to investigate what the latest studies point out in the clinical treatment of GERD. METHODOLOGY: This is a bibliographic review whose secondary data were obtained through articles from Google Scholar, Scielo and PubMed databases. The descriptors were defined by the Decs BVS in “Gastroesophageal Reflux Disease”, “Clinical treatment” and “Non-pharmacological measures”, and hundreds of articles from national and international literature were identified. For the purpose of this literature review, only articles published in the last 2 years were included to discuss the clinical treatment of the disease. RESULTS: The therapeutic approach to GERD includes two modalities, clinical and surgical treatment, the choice of which depends on the patient's characteristics, in addition to other factors such as response to treatment, presence of erosions in the esophageal mucosa, atypical symptoms and complications. Clinical treatment aims to relieve symptoms, heal esophageal mucosal lesions and prevent the development of complications. It is based on non-pharmacological and pharmacological measures. Anti-reflux surgery must be reserved for patients who do not respond to medical treatment and/or who have life-threatening conditions. After the emergence of more potent prokinetic agents and acid secretion inhibitors, the role of surgery as a definitive therapeutic weapon for complicated reflux has been questioned. CONCLUSIONS: Surgical treatment, when properly indicated, tends to be a definitive way to resolve the typical and atypical symptoms of GERD. On the other hand, considering the multidimensional etiopathogenesis of the disease, clinical treatment is still the best alternative to start with. It is understandable that the adjustment of doses, the association of classes, the combination with behavioral measures and the due adherence by the patient are presented as determinant measures for the therapeutic success, being able to avoid a surgical approach in most cases.