Review article: alternative approaches to the long‐term management of GERD

Summary Although proton‐pump inhibitors are highly effective for the treatment of gastro‐oesophageal reflux disease, there are issues with long‐term maintenance therapy: not all patients require full daily dose for maintenance treatment, some patients are reluctant to take long‐term daily medication, and long‐term PPI therapy is inadequate for some patients. This article aims to review alternatives to daily proton‐pump inhibitor therapy for the long‐term management of gastro‐oesophageal reflux disease, including intermittent or on‐demand proton‐pump inhibitor use, as well as endoscopic and surgical options. On‐demand proton‐pump inhibitor therapy has demonstrated efficacy in achieving acceptable symptom control, healing and maintenance of quality of life for a proportion of patients with gastro‐oesophageal reflux disease. Endoscopic antireflux procedures can reduce the need for proton‐pump inhibitor therapy, but safety and durability of these procedures require more study. Surgical treatment of gastro‐oesophageal reflux disease in properly selected patients has demonstrated efficacy in reducing symptoms and the need for proton‐pump inhibitor therapy; however, long‐term follow‐up suggests that it is not a permanent solution for many patients. While daily proton‐pump inhibitor therapy remains the main treatment regimen option for most patients with gastro‐oesophageal reflux disease, on‐demand therapy may prove effective for many patients. Endoscopic anti‐reflux therapies and surgery are options for patients who prefer nonpharmacological treatment, but experience is limited at this point in time for the former.