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Can Fam Physician
Vol. 54, No. 5, May 2008, pp.701 - 705
Copyright © 2008 by The College of Family Physicians of Canada
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Clinical Review

Approach to gastroesophageal reflux disease in primary care

Putting the Montreal definition into practice

Nigel Flook, MD
Family physician and an Associate Clinical Professor in the Department of Family Medicine at the University of Alberta in Edmonton

Roger Jones, DM
Teaches at King’s College in London, England

Nimish Vakil, MD
Clinical Professor of Medicine at the University of Wisconsin School of Medicine and Public Health in Madison and also teaches at the Marquette University College of Health Sciences in Milwaukee

Correspondence to: Dr N. Flook, University of Alberta Hospital, 1A1.11, 8440–112 St, Edmonton, AB T6G 2B7; telephone 780 433-4211; fax 780 407-1828; e-mail nflook{at}shaw.ca

OBJECTIVE To apply the recently published Montreal definition of gastroesophageal reflux disease (GERD) in primary care.

SOURCES OF INFORMATION The Montreal definition of GERD was developed by an international consensus group of experts in GERD and primary care physicians using rigorous evidence-based methods along with modern consensus development techniques and a patient-centred approach.

MAIN MESSAGE Gastroesophageal reflux disease can be diagnosed in primarycare based on symptoms alone without additional diagnostic testing. Symptoms reach a threshold where they constitute disease when they are troublesome (cause difficulty) to patients. In addition to the cardinal symptoms of heartburn and regurgitation, people with GERD can also have sleep disturbances, chest pains, or respiratory symptoms. Monitoring patients’ response to proton pump inhibitor therapy can confirm the success of management. Treatment for symptoms of GERD can also heal underlying reflux esophagitis if it is present.

CONCLUSION Primary care physicians can diagnose and manage GERD confidently in most patients by investigating and treating troublesome symptoms without the need for additional investigations or referral to specialists.






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