Recent advances in management of gastroesophageal reflux

Gastroesophageal reflux is not synonymous with sliding hiatus hernia. It should be approached as a condition dependent on the intrinsic strength of the lower esophageal sphincter rather than on the presence of a hiatus hernia. The patient's account of symptoms is probably the most important means of diagnosis, but in addition the patient's history should be supplemented by radiographic evaluation. Initially the treatment of gastroesophageal reflux is one of prevention. If this conservative approach proves ineffective, drugs that restore sphincter strength can be tried. Surgery should be resorted to only if medical treatment fails, and then one of the newer specific antireflux procedures should be the operation of choice.