Gastroesophageal reflux disease

Gastroesophageal reflux affects more than 100 million US adults and costs the health care system more than $9 billion annually. The diagnosis can be made clinically in most cases without the use of upper endoscopy. Erosive esophagitis, the hallmark diagnostic finding on upper endoscopy, is present in 15-50% of patients with chronic gastroesophageal reflux symptoms. Upper endoscopy is warranted in some instances, however, including patients with alarm symptoms of GERD, those with persistent symptoms despite a therapeutic trial of 6-8 weeks of twice-daily proton pump inhibitor therapy, to assess healing of severe erosive esophagitis and the presence of Barrett’s esophagus after a 2-month course of proton pump inhibitor therapy, and patients with a history of peptic stricture who develop recurrent dysphagia. Clinicians should be familiar with other conditions whose symptoms can be mistaken for those of gastroesophageal reflux disease.