A review of reflux esophagitis around the world

Table 1 Prevalence of reflux in various geographic sites(%)

	Weekly symptoms	Monthly symptoms	Endoscopic damage
U.S.A.[1,2,10]	19.8	36	7
Europe[8,37,39,40]	12-23	21-34	2
East Asia[4,7,8,9]	14		1.5-5

Table 2 Pathophysiologic factors contributing to the development of reflux

Incompetent lower esophageal sphincter

Low pressure sphincter

Short sphincter length

Poor esophageal peristalsis

Decreased amplitude of contractions

Absence of propagated peristalsis

Delayed gastric emptying

Inadequate gastric contractions

Partial gastric outlet obstruction

Mucosal susceptablity to refluxate

Acid

Pepsin

Bile

Duodenal fluid

Table 3 Pharmacologic agents used in the treatment of reflux

	Dosage1	Possible mechanism
H2 receptor antagonist
Cimetidine	800 mg bid or 400 mg qid	Reduce acid
Famotidine	20 mg bid or 40 mg bid	Reduce acid
Nizatidine	150 mg bid	Reduce acid, prokinetic
Ranitidine	150 mg qid	Reduce acid
Proton pump inhibitor
Lansoprazole	30 mg qd	Reduce acid
Omeprazole	20 mg qd	Reduce acid
Prokinetic
Cisapride	10 mg qid or 20 mg qid	Prokinetic
Metoclopramide	15 mg qid	Prokinetic

¹Dosages for erosive esophagitis, except for cisapride which is suggested for symptomatic treatment only[41].