Gastro-oesophageal reflux disease is an increasingly common problem in the community, and most patients are managed in general practice. A symptom-based diagnosis can besupported by a trial of therapy. Most patients will require long-term treatment.
- A careful history is the most useful method for the diagnosis of reflux disease.
- A symptom-based diagnosis can be supported by a trial of proton pump inhibitor (PPI) therapy.
- Endoscopic abnormalities are found in fewer than half of all patients with reflux symptoms.
- Investigations are warranted if the diagnosis is unclear, symptoms persist despite treatment, or alarm symptoms suggest complications.
- Initial therapy with a standard dose of a PPI is the most effective treatment.
- Most patients will require long term treatment; intermittent, symptom-driven, on-demand treatment with PPIs is a cost effective approach in many patients.
- In experienced hands, antireflux surgery is an effective alternative to PPI therapy in the long term management of reflux disease.