Gastroesophageal reflux disease. Medical aspects.

Symptomatic gastroesophageal reflux is one of the most common complaints encountered by clinicians. The pathogenesis of reflux remains unclear, but multiple factors are involved. Heartburn is the most common clinical manifestation. The history and barium esophagram provide sufficient diagnostic information in most cases. Other studies, including ambulatory pH monitoring, the Bernstein test, endoscopy with biopsy, and esophageal manometry, are warranted if the patient has atypical symptoms, an incomplete response to therapy, dysphagia, or abnormalities on the esophagram. Proper utilization of these studies requires an understanding of the questions each test answers. Reflux disease is often a chronic problem. Many patients can be treated symptomatically by a combination of life-style modifications and use of antacids. Patients who do not respond adequately to these simple measures or who have documented erosive esophagitis usually require further drug therapy.