Management of gastro-oesophageal reflux disease in general practice

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Abstract
Gastro-oesophageal reflux disease is a potentially serious condition that can greatly reduce patients' quality of life and carries a risk of oesophagitis and complications.1 It is a common condition and a considerable burden on healthcare resources. Most patients are managed in general practice, and effective management of the disease remains a challenge. Guidelines produced in Europe, 2 3 the United States,4 and Canada5 do not give consistent recommendations. #### Summary points Careful analysis of symptoms and history is key to diagnosis of gastro-oesophageal reflux disease Diagnosis based on symptoms can be aided by a trial of treatment Clear endoscopic abnormalities are found in less than half of patients Treatment should start with the most effective therapy—a proton pump inhibitor Most patients will require long term management, for which the guiding principle is to reduce to the least costly treatment that is effective in controlling symptoms Antireflux surgery may be as effective as long term proton pump inhibitors but is less predictable An international multidisciplinary workshop was held in Genval, Belgium, in 1999 to evaluate the literature on gastro-oesophageal reflux disease, including numerous reviews,6–8 in the light of clinical experience.9 Participants voted on their level of support and the strength of the evidence for a series of statements relevant to the management of the disease. In this article we summarise the conclusions of the Genval workshop and present an overview of the latest thinking on the management of gastro-oesophageal reflux disease relevant to general practice. We also reviewed relevant articles published since the workshop, which we identified by a search of the electronic databases Medline and Embase from 1997 to March 2000, using the search term gastro-oesophageal reflux in combination with various key words for drug therapy, surgery, cost effectiveness, and quality of life. Gastro-oesophageal reflux disease …

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