Gastro-oesophageal Reflux Disease in General Practice

Abstract

Symptoms of reflux-like dyspepsia and gastro-oesophageal reflux disease (GORD) are common problems in the community and in general practice. The 1-year prevalence of reflux-like dyspepsia is in the region of 30%, with many patients experiencing a range of other symptoms in addition to the principal complaint of retrosternal pain or burning. Although only a minority, about one-quarter, of these patients consult general practitioners about their problems, many of them have had symptoms for several years, and experience symptoms on a frequent, often daily, basis. The decision to consult a general practitioner often depends more upon patients' anxieties about the possibility of heart disease and cancer than on symptom severity. General practitioners need to address these issues, as well as attempting to make a safe, clinical diagnosis; this is aided by the findings that, at least in patients under the age of about 45, a reasonably confident clinical diagnosis can be made on the basis of symptoms alone, although older patients and those in whom alarm symptoms are present require timely investigation. The increasing availability of open-access endoscopy means that many of these patients can be managed entirely in general practice without the need for specialist referral. Management in general practice begins with a clear explanation of the mechanisms and significance of GORD and a direct response to patients' anxieties. Lifestyle factors may require modification before drug therapy begins. At present it appears that, because of the relatively low frequency of complications and severe morbidity of GORD seen by general practitioners, many patients do not go on to receive optimal therapy, in terms of potent acid-suppressing agents, with a substantial number of patients continuing to experience significant symptoms after consultation with their general practitioner. A clear, evidence-based management strategy incorporating acid-suppressing and prokinetic agents for use in general practice is required.

Key Words:

• Gastro-oesophageal reflux disease
• general practice