Controversial issues in gastroesophageal reflux disease.

The management of gastroesophageal reflux disease (GERD) has advanced dramatically in the past 20 years because of increased understanding of its pathophysiology and improvements in available treatments. A number of important new ideas arousing controversy include the place of over-the-counter H2 receptor antagonists; the role of endoscopy in diagnosis of reflux symptoms; initial treatment options with regard to stepping up therapy to the most effective as needed or stepping down therapy from a proton pump inhibitor given initially because of its superior efficacy in all grades of reflux disease; the optimal choice of long term management of patients with GERD or GERD complicated by Barrett's metaplasia; the risk of Barrett's metaplasia; and the role of surveillance of this population. This paper reviews these topics and addresses the controversial issues.