Clinical Review

Management of gastro-oesophageal reflux disease in general practice

BMJ 2001; 322 doi: 10.1136/bmj.322.7282.344 (Published 10 February 2001)
Cite this as: BMJ 2001;322:344

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  1. John Dent, professor of medicinea,
  2. Roger Jones (roger.jones@kcl.ac.uk), professor of general practiceb,
  3. Peter Kahrilas, professor of medicinec,
  4. Nicholas J Talley, professor of medicined
  1. a Department of Gastroenterology, Hepatology, and General Medicine, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
  2. b Department of General Practice and Primary Care, Guy's, King's, and St Thomas' School of Medicine, London SE11 6SP
  3. c Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Medical School, Chicago, IL 60611-3008, USA
  4. d Department of Medicine, University of Sydney, Nepean Hospital, Penrith, PO Box 63, NSW 2751, Australia
  1. Correspondence to: R Jones
  • Accepted 3 January 2001

Introduction

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

Methods

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.

Definition of gastro-oesophageal reflux

Gastro-oesophageal reflux disease …

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