PMID- 29034088
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201214
IS  - 2046-1402 (Print)
IS  - 2046-1402 (Electronic)
IS  - 2046-1402 (Linking)
VI  - 6
DP  - 2017
TI  - Emerging dilemmas in the diagnosis and management of gastroesophageal reflux 
      disease.
PG  - 1748
LID - 10.12688/f1000research.11918.1 [doi]
LID - 1748
AB  - Gastroesophageal reflux disease (GERD) is common, but less so than widely 
      reported because of inconsistencies in definition. In clinical practice, the 
      diagnosis is usually based on a symptom assessment without testing, and the 
      extent of diagnostic testing pursued should be limited to that which guides 
      management or which protects the patient from the risks of a potentially morbid 
      treatment or an undetected early (or imminent) esophageal adenocarcinoma or which 
      does both. When testing is pursued, upper gastrointestinal endoscopy is the most 
      useful initial diagnostic test because it evaluates for the major potential 
      morbidities (Barrett's, stricture, and cancer) associated with GERD and 
      facilitates the identification of some alternative diagnostic possibilities such 
      as eosinophilic esophagitis. However, endoscopy is insensitive for diagnosing 
      GERD because most patients with GERD have non-erosive reflux disease, a 
      persistent diagnostic dilemma. Although many studies have tried to objectify the 
      diagnosis of GERD with improved technology, this is ultimately a pragmatic 
      diagnosis based on response to proton pump inhibitor (PPI) therapy, and, in the 
      end, response to PPI therapy becomes the major indication for continued PPI 
      therapy. Conversely, in the absence of objective criteria for GERD and the 
      absence of apparent clinical benefit, PPI therapy is not indicated and should be 
      discontinued. PPIs are well tolerated and safe, but nothing is perfectly safe, 
      and in the absence of measurable benefit, even a miniscule risk dominates the 
      risk-benefit assessment.
FAU - Kahrilas, Peter
AU  - Kahrilas P
AUID- ORCID: 0000-0002-8260-1250
AD  - Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 
      St. Clair Street, 14th floor, Chicago, IL, 60611-2951, USA.
FAU - Yadlapati, Rena
AU  - Yadlapati R
AD  - Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 
      St. Clair Street, 14th floor, Chicago, IL, 60611-2951, USA.
FAU - Roman, Sabine
AU  - Roman S
AD  - Digestive Physiology, Hospices Civils de Lyon and Lyon I University, Lyon, 
      France.
LA  - eng
GR  - R01 DK092217/DK/NIDDK NIH HHS/United States
GR  - T32 DK101363/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Review
DEP - 20170925
PL  - England
TA  - F1000Res
JT  - F1000Research
JID - 101594320
PMC - PMC5615773
OTO - NOTNLM
OT  - GERD
OT  - PPI
COIS- Competing interests: The authors declare that they have no competing interests.No 
      competing interests were disclosed.No competing interests were disclosed.
EDAT- 2017/10/17 06:00
MHDA- 2017/10/17 06:01
PMCR- 2017/09/25
CRDT- 2017/10/17 06:00
PHST- 2017/09/26 00:00 [accepted]
PHST- 2017/10/17 06:00 [entrez]
PHST- 2017/10/17 06:00 [pubmed]
PHST- 2017/10/17 06:01 [medline]
PHST- 2017/09/25 00:00 [pmc-release]
AID - 10.12688/f1000research.11918.1 [doi]
PST - epublish
SO  - F1000Res. 2017 Sep 25;6:1748. doi: 10.12688/f1000research.11918.1. eCollection 
      2017.