Controversial issues in gastroesophageal reflux disease.
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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.
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