© 2004 Canadian Medical Association or its licensors Commentary

Gastroesophageal reflux disease (GERD) affects17–40 % of North Americans1,2 and is increasing inincidence.3 Although some suspect that the rise in GERD is an artifact of improved diagnosis, others have postulated a relation to the declining rate of Helicobacter py-lori-related gastritis, which may have protected against GERD by causing gastric hypochlorhydria.3 GERD is a risk factor for esophageal cancer. In a case–control study,4 people with esophageal adenocarci-noma were found to be much more likely to have had re-current symptomatic GERD than age- and sex-matched members of the control group (odds ratio 7.7, 95 % confi-dence interval [CI] 5.3–11.4). Drugs, such as proton-pump inhibitors (PPIs), are highly effective in the treatment of GERD,5 but relapse is frequent after medications are discontinued,6 and long-term therapy is often required