Gastroesophageal reflux disease. Control of symptoms, prevention of complications.

GERD is a common disease that has a significant impact on patients' quality of life. Many surveys have shown that up to 60% of the population suffers from GERD at some time. Heartburn and acid regurgitation are the classic symptoms, but manifestations are variable. Of the several extraesophageal manifestations of GERD, reflux-induced asthma may be the most important. Complications of GERD include peptic strictures of the esophagus and Barrett's metaplasia. Clinical diagnosis of GERD can be confirmed by response to antisecretory therapy. A high-dose trial of a PPI is becoming an accepted diagnostic technique for uncomplicated mild or moderate GERD. Endoscopic examination and ambulatory esophageal pH monitoring still have a role in the evaluation of severe GERD or when other diseases are suspected. Lifestyle changes rarely are beneficial, and antisecretory therapy remains the mainstay of GERD treatment. PPIs have been shown to be more effective than H2 blockers. Antireflux surgery is indicated in some patients. Healing of esophagitis can take up to 8 weeks; failure to control symptoms necessitates the use of higher drug doses. Failure to control symptoms with high-dose PPI treatment raises the likelihood of other causes.