Reflux Symptoms: Functional and Structural Diseases and the Approach from the GI Specialist.

The GI specialist has an important role to play in the long-term management of gastroesophageal reflux disease (GERD) patients to secure a proper diagnosis and the selection of best possible therapeutic strategy. Through intensified information and education, the implementation of national and international guidelines can be more effectively processed, whereupon a significant improvement in cost-effectiveness of the current management will be fostered. Regarding the more specific group of GERD patients, as represented by the so-called PPI-refractory patients, data have now emerged to guide us into the future. Noteworthy is that the majority of the alleged PPI-refractory GERD patients do not, after careful investigations, have GERD. Based on recently published RCT data, a clinically highly relevant difference in treatment success was noted in favor of laparoscopic antireflux surgery as compared to a variety of medical treatment alternatives. Likewise, it can be concluded that it seems as if the latter can only offer a limited effect. Whenever a corresponding powerful clinical difference in therapeutic outcome between different strategies and treatment alternatives is detected, this will have a huge impact on treatment algorithms and clinical management.