The importance of symptom assessment in the surgical treatment of gastroesophageal reflux disease and Barrett's esophagus.
The "art" and science of symptom assessment in the evaluation of patients with gastroesophageal reflux disease has been under emphasized. In fact, it is critical to judgements regarding surgical versus non-surgical therapy and is much more difficult than meets the eye. Many symptoms thought to be secondary to gastroesophageal reflux are not, and some, such as asthma cough and chest pain, which are commonly thought secondary to other causes, are indeed symptoms of reflux. Diagnostic studies are helpful but far from perfect, ultimately requiring the clinician's expert judgement as the key factor in determining a successful outcome. The following outlines both an approach to the assessment of symptoms and when possible, clinical studies shedding light on their cause and interpretation.
Division of Thoracic and Foregut Surgery, Department of Surgery, University of Rochester, Rochester, NY, USA. jeffrey_peters@urmc.rochester.edu
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Peters
D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D000787:Angina Pectoris / Q000175:diagnosis; D000855:Anorexia / Q000175:diagnosis / Q000209:etiology; D001249:Asthma / Q000175:diagnosis / Q000209:etiology; D001471:Barrett Esophagus / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D001921:Brain / Q000503:physiopathology; D002404:Catheterization; D002637:Chest Pain / Q000209:etiology; D003371:Cough / Q000175:diagnosis / Q000209:etiology; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods; D015154:Esophageal Motility Disorders / Q000175:diagnosis / Q000209:etiology; D005071:Evoked Potentials; D005744:Gastric Acid; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006685:Hoarseness / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000175:diagnosis; D043183:Irritable Bowel Syndrome / Q000175:diagnosis / Q000209:etiology; D008365:Manometry; D008487:Medical History Taking; D009325:Nausea / Q000175:diagnosis / Q000209:etiology; D010808:Physical Examination; D011300:Preoperative Care; D013272:Stomach Diseases / Q000150:complications / Q000175:diagnosis; D015431:Weight Loss
D006635:Histamine H2 Antagonists