title: Controversial issues in gastroesophageal reflux disease.
abstract: 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.
authors.affiliation: Division of Gastroenterology, McMaster University, Hamilton, Ontario. huntr@fhs.mcmaster.ca
authors.forename: R H
authors.initials: RH
authors.lastname: Hunt
mesh_terms: D001471:Barrett Esophagus / Q000150:complications / Q000188:drug therapy; D004945:Esophagoscopy; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D054328:Proton Pump Inhibitors
chemical_list: D054328:Proton Pump Inhibitors