"Treat first, endoscope later" in GORD

doi:10.1136/bmj.332.7533.0-d

BMJ 2006;332 (14 January), doi:10.1136/bmj.332.7533.0-d

"Treat first, endoscope later" in GORD

A clinical review of gastro-oesophageal reflux disease (GORD)on p 88 finds enough evidence on the use of acid suppressionin patients with "typical reflux symptoms" but only a few largeand well done studies investigating patients with atypical symptomsand non-erosive oesophagitis, in whom acid suppression is lesseffective. Fox and Forgacs explain why the approach has shiftedto looking at GORD as a family of diseases. The new model shiftsattention to oesophageal symptoms, rather than injury to theoesophageal mucosa, and the corresponding shift in the NICEguidelines to "treat first, endoscope later" should benefitendoscopy negative patients with severe symptoms, they say.