EOR Treatment

The main objectives of EOR management are:

  • To decrease the frequency and duration of reflux episodes
  • To decrease the irritative nature of gastric secretions.[Irwin RS, 1998]

In contrast with GORD, EOR symptoms do not respond quickly to treatment and can take several months to resolve.[Koufman J, 1996] Treatment should continue for 2–6 months.[Postma GN, 2002] If the patient is then asymptomatic, treatment can be decreased or stopped.

It is possible that EOR will relapse, and intervals between recurrences can vary from months to years, whereas some patients will need continuous lifetime treatment.

Treatment of EOR should vary according to the severity of the disease:

  • For minor EOR, lifestyle changes, such as a change in diet to reduce spicy foods, alcohol and caffeine, reduction in smoking and weight loss, should improve the symptoms. These should be accompanied by the step-wise administration of antacids, reflux suppressants (eg, Gaviscon Advance),H2-receptor antagonists or prokinetic agents
  • For severe EOR, dietary and lifestyle changes, as well as high-dose twice-daily proton pump inhibitor (PPI) therapy, given in combination with a reflux suppressant, is recommended
  • For life-threatening EOR, more aggressive therapy with three- or four-times daily PPIs is required. Fundoplication may also be required.[Postma GN, 2002] It is also recommended that all patients undergo pH monitoring before treatment starts.

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