Intended for healthcare professionals

Primary Care

Gastro-oesophageal reflux disease

BMJ 2002; 325 doi: (Published 26 October 2002) Cite this as: BMJ 2002;325:945
  1. Janusz Jankowski, professor (,
  2. Roger Jones, Wolfson professor of general practiceb,
  3. Brendan Delaney, reader in primary care and general practicec,
  4. John Dent,, professor of gastroenterologyd
  1. aDigestive Diseases Centre and Epithelial Office, Departments of Medicine and Oncology, Leicester Royal Infirmary, Leicester LE1 5WW,
  2. bGuy's, King's, and St Thomas's School of Medicine, King's College, London,
  3. cUniversity of Birmingham, Birmingham,
  4. dRoyal Adelaide Hospital, Adelaide, Australia
  1. Correspondence to: J Jankowski

    This is part of a series of occasional articles on common problems in primary care

    A 45 year old man complains of heartburn (retrosternal burning) and regurgitation, usually after food but also at night, for six months. Symptoms are particularly bad after a heavy, fatty meal. Physical straining, bending, stooping, or lying flat also worsen the symptoms.

    What issues you should cover

    • Heartburn is common (7% of adults have daily and 35% monthly symptoms) and is chronic and relapsing but usually benign. Consider why the patient has consulted; many are worried about heart disease or cancer.

    • In two thirds of patients, heartburn does not progress. Those with longstanding disease (>5 years), however, may develop more severe symptoms as a result of secondary strictures or ulcers.

    • In patients not receiving treatment, severity of heartburn does not predict the presence, absence, or severity of oesophagitis. More specific symptoms for reflux are postural symptoms, a rising from lower to upper …

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