Most patients with dominant heartburn have no signs of oesophagitis at endoscopy. However, chronic relapsing gastro-oesophageal reflux disease can severely affect quality of life In primary care many patients can be successfully treated by intermittent courses of drugs on demand. Alginate-antacids and H2 receptor antagonists are useful in patients with mild disease Cisapride is as effective as H2 receptor antagonists in short term treatment and can prevent relapse in mild oesophagitis Proton pump inhibitors relieve symptoms and heal oesophagitis more completely and faster than other drugs. They are effective throughout the disease spectrum, and maintenance therapy prevents recurrences. The principles of laparoscopic and open antireflux surgery are the same. In skilled hands, similarly good results have been reported up to two years after both approaches In young fit patients laparoscopic surgery may be a cost effective alternative to a lifetime of drug treatment.
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