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J Clin Outcomes Manage
2011 Jan;18(1):615-623
Gastroesophageal reflux disease: clinical features and management for the primary care physician
Behm BW, Peura DA
Abstract: Objective: To provide an overview of the clinical features, diagnosis, and medical management of gastroesophageal reflux disease (GERD). Methods: Review of recent literature relating to epidemiology, diagnosis, and management of GERD. Results: GERD is a common condition that results from reflux of gastric contents into the esophagus, leading to bothersome symptoms or complications such as esophagitis or Barrett’s esophagus. It can impact quality of life and productivity at home and in the workplace. Several factors, including the epidemic of obesity, are fueling the rising incidence of GERD in the United States. Diagnosis of GERD can reliably be made based on fairly specific clinical symptoms and response to acid suppressive medication. Proton pump inhibitors (PPIs) are the gold standard for GERD treatment, but they have inherent dosing limitations that can influence their effectiveness. Once symptoms are controlled, medication should generally be tapered and decreased to the lowest dose and dosing interval that controls symptoms, barring complicated GERD. Avoiding high-dose chronic PPI treatment whenever possible may mitigate some of the adverse effects associated with acid suppression. Persistent, longstanding, severe, or poorly controlled symptoms, especially if they occur at night, should prompt one-time endoscopy to evaluate for esophagitis and alternative causes of symptoms. Conclusion: In most instances, a reliable diagnosis of GERD can be made based on typical presenting symptoms and response to empiric acid suppressive medication. Medical management can control symptoms and improve the quality of life in most GERD patients.
Case-Based Review
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