Feature Article

Update on gastro-oesophageal reflux disease

Feature Article

Update on gastro-oesophageal reflux disease

Edmund Tse, Richard H Holloway

Abstract

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.

Key Points

  • 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.