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Gastroesophageal reflux disease.
JAMA 1996; 276(12):983-8JAMA

Abstract

OBJECTIVE

To review the management of gastroesophageal reflux disease (GERD) in adults with esophageal complications (esophagitis, stricture, adenocarcinoma, or Barrett metaplasia) or extraesophageal complications (otolaryngological manifestations and asthma).

DATA SOURCES

Peer-reviewed publications located via MEDLINE or cross-citation.

STUDY SELECTION

Emphasis was placed on new developments in diagnosis and therapeutics. Thus, fewer than 10% of identified citations are discussed.

DATA EXTRACTION

Controlled therapeutic trials were emphasized. The validity of pathophysiological observations and uncontrolled trials were critiqued by the author.

DATA SYNTHESIS

Esophagitis is typically a chronic, recurring disorder treated with long-term antisecretory therapy, titrated to disease severity. Laparoscopic [correction of Laparascopic] antireflux surgery is an alternative strategy, but neither long-term efficacy data nor an appropriate controlled trial comparing it with proton pump inhibitor therapy exists. The main risk of esophagitis is adenocarcinoma arising from Barrett metaplasia, the incidence of which is increasing. Strong evidence suggests that both reflux-induced asthma and otolaryngological complications (subglottic stenosis, laryngitis, pharyngitis, or cancer) can occur without esophagitis. While the otolaryngological manifestations usually respond to antisecretory medications, reflux-induced asthma responds convincingly only to antireflux surgery.

CONCLUSIONS

Although esophagitis and GERD symptoms predictably respond to antisecretory medicines, the risk of adenocarcinoma from Barrett metaplasia dictates that if heartburn is refractory to treatment, chronic (>5 years), or accompanied by dysphagia, odynophagia, or bleeding, it should be evaluated by endoscopy. Thereafter, patients with Barrett metaplasia require surveillance endoscopy to control the cancer risk. Reflux-induced asthma remains a vexing problem in the absence of either medical therapy or proven efficacy of a reliable mechanism of prospectively identifying affected patients.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Medical School, Chicago, Ill. 60611, USA.

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.
Review

Language

eng

PubMed ID

8805734

Citation

Kahrilas, P J.. "Gastroesophageal Reflux Disease." JAMA, vol. 276, no. 12, 1996, pp. 983-8.
Kahrilas PJ. Gastroesophageal reflux disease. JAMA. 1996;276(12):983-8.
Kahrilas, P. J. (1996). Gastroesophageal reflux disease. JAMA, 276(12), pp. 983-8.
Kahrilas PJ. Gastroesophageal Reflux Disease. JAMA. 1996 Sep 25;276(12):983-8. PubMed PMID: 8805734.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gastroesophageal reflux disease. A1 - Kahrilas,P J, PY - 1996/9/25/pubmed PY - 1996/9/25/medline PY - 1996/9/25/entrez SP - 983 EP - 8 JF - JAMA JO - JAMA VL - 276 IS - 12 N2 - OBJECTIVE: To review the management of gastroesophageal reflux disease (GERD) in adults with esophageal complications (esophagitis, stricture, adenocarcinoma, or Barrett metaplasia) or extraesophageal complications (otolaryngological manifestations and asthma). DATA SOURCES: Peer-reviewed publications located via MEDLINE or cross-citation. STUDY SELECTION: Emphasis was placed on new developments in diagnosis and therapeutics. Thus, fewer than 10% of identified citations are discussed. DATA EXTRACTION: Controlled therapeutic trials were emphasized. The validity of pathophysiological observations and uncontrolled trials were critiqued by the author. DATA SYNTHESIS: Esophagitis is typically a chronic, recurring disorder treated with long-term antisecretory therapy, titrated to disease severity. Laparoscopic [correction of Laparascopic] antireflux surgery is an alternative strategy, but neither long-term efficacy data nor an appropriate controlled trial comparing it with proton pump inhibitor therapy exists. The main risk of esophagitis is adenocarcinoma arising from Barrett metaplasia, the incidence of which is increasing. Strong evidence suggests that both reflux-induced asthma and otolaryngological complications (subglottic stenosis, laryngitis, pharyngitis, or cancer) can occur without esophagitis. While the otolaryngological manifestations usually respond to antisecretory medications, reflux-induced asthma responds convincingly only to antireflux surgery. CONCLUSIONS: Although esophagitis and GERD symptoms predictably respond to antisecretory medicines, the risk of adenocarcinoma from Barrett metaplasia dictates that if heartburn is refractory to treatment, chronic (>5 years), or accompanied by dysphagia, odynophagia, or bleeding, it should be evaluated by endoscopy. Thereafter, patients with Barrett metaplasia require surveillance endoscopy to control the cancer risk. Reflux-induced asthma remains a vexing problem in the absence of either medical therapy or proven efficacy of a reliable mechanism of prospectively identifying affected patients. SN - 0098-7484 UR - https://www.unboundmedicine.com/medline/citation/8805734/full_citation L2 - https://jamanetwork.com/journals/jama/fullarticle/vol/276/pg/983 DB - PRIME DP - Unbound Medicine ER -