Studies with short-term administration of omeprazole in patients with erosive or ulcerative reflux oesophagitis have demonstrated that strong inhibition of gastric acid secretion will become the therapy of choice for these patients. However, because reflux oesophagitis relapses rapidly when short-term treatment is discontinued, these patients are candidates for maintenance treatment. In most cases, long-term treatment will also require strong inhibition of gastric acidity. Until more information on the long-term safety of strong inhibition of gastric acid secretion is available, this therapeutic option should preferably be restricted to those patients who do not respond appropriately to other therapeutic regimens. Future studies are needed to determine whether higher doses of histamine H2-receptor antagonist are equally efficacious as omeprazole in ulcerative oesophagitis and whether profound acid inhibition is also needed to alleviate reflux symptoms in patients with an intact oesophageal mucosa.