Long-term GERD management: the individualized approach.

Gastroesophageal reflux disease (GERD) is a complex condition, and both mucosal lesions and symptoms are important parameters in evaluating disease severity and the impact of treatment. An individualized approach in which treatment is tailored to each patient is the appropriate strategy. Treatment with a standard dose of a proton pump inhibitor (PPI) should be continued until symptoms resolve in the case of nonerosive reflux disease (NERD), or until complete remission is achieved (resolution of symptoms and endoscopically confirmed healing) in patients with erosive disease. Maintenance treatment with a half-dose PPI is effective in both erosive esophagitis and NERD. If NERD patients remain in remission with the half-dose PPI, therapy can continue in an on-demand basis. A relapse of symptoms often needs to be treated by a return to a full-dose PPI. Studies of long-term treatment with PPIs show that they are a safe and effective means of maintaining remission in patients with GERD.