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A systematic medline search of the medical literature was performed using Ovid in July 2007. The search was limited to human subjects, English language and the time frame of 1998 to 2007. Subject headings included gastroesophageal reflux disease, guidelines, clinical trials, and review articles.

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Gastroesophageal reflux disease (GERD) is a common disorder seen in the primary care setting. It is described as symptoms or mucosal damage that occurs when the gastric contents are abnormally refluxed into the esophagus.1 A defective lower esophageal sphincter pressure plays an important role in the development of GERD. Other contributing factors include defects of the normal mucosal “defense mechanisms” such as anatomic factors, esophageal clearance, mucosal resistance, and gastric emptying. In addition, “aggressive factors,” such as gastric acid, pepsin, bile acids, and pancreatic enzymes may play a role in the development of GERD.

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The prevalence and incidence of GERD are hard to predict because of many patients not going to their health care provider for evaluation, symptoms not always correlating with disease severity, and the lack of a universal method for diagnosing the disease.2 Most patients can be characterized as having (1) nonerosive reflux disease, (2) erosive esophagitis, or (3) Barrett’s esophagus.3 Nonerosive reflux disease, also known as endoscopy-negative GERD or “symptomatic” GERD, occurs in patients experiencing GERD symptoms with no evidence of mucosal damage per endoscopy. Patients with nonerosive reflux disease may experience symptoms as severe as those with erosive esophagitis and should be treated similarly. Others may present with erosions of the esophagus as a result of repeated exposure of refluxed material for prolonged periods of time (erosive esophagitis). Still others may present with complications of GERD, such as Barrett’s esophagus. This occurs when the normal squamous epithelial lining is replaced with specialized columnar-type epithelium during the reparative process. GERD affecting organ systems outside the esophagus is referred to as atypical, or extra-esophageal GERD.

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The diagnosis of GERD is generally made based upon symptoms reported to the health care provider by the patient. If these symptoms are relieved by empiric acid-suppressing therapy, a clinical diagnosis of GERD can be made. However, those patients not responding to therapy, or those presenting with atypical or complicated symptoms require further diagnostic evaluation. The primary care provider should recognize the differences in presentation and be prepared to treat appropriately. Patients presenting with complicated or atypical symptoms should be referred to a specialist.

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GERD symptoms are described as typical, atypical, or complicated4 (Table 10-1).

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Table 10-1. Clinical Presentation Of GERD4
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Heartburn and regurgitation are common, highly specific symptoms of GERD....

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