Gastroesophageal reflux disease

A 53-year-old man, who is otherwise healthy and has a 20-year history of occasional heartburn, reports having had worsening heartburn for the past 12 months, with daily symptoms that disturb his sleep. He reports having had no dysphagia, gastroin-testinal bleeding, or weight loss and in fact has recently gained 20 lb (9 kg). What would you advise regarding his evaluation and treatment? The Clinic a l Problem Gastroesophageal reflux disease is the most common gastrointestinal diagnosis re-corded during visits to outpatient clinics.1 In the United States, it is estimated that 14 to 20 % of adults are affected, although such percentages are at best approxima-tions, given that the disease has a nebulous definition and that such estimates are based on the prevalence of self-reported chronic heartburn.2 A current definition of the disorder is “a condition which develops when the reflux of stomach contents causes troublesome symptoms (i.e., at least two heartburn episodes per week) and/or complications.”3 Several extraesophageal manifestations of the disease are well rec-ognized, including laryngitis and cough (Table 1). With respect to the esophagus