Introduction. GERD warrants increased physician appreciation and improved treatment

Many primary care physicians and the public have long considered GERD to be a nuisance disorder that has a modest negative impact and few long-term complications. Until just recently, both groups also underappreciated the significance of nocturnal heartburn. However, the information presented in this Special Report shows that nocturnal heartburn has a major adverse effect on patients' lives. In fact, most experts in the field of gastroenterology believe that prolonged exposure of the esophagus to the acidic contents of the stomach eventually leads to Barrett's esophagus in certain patients. Over time, Barrett's metaplasia may become dysplastic and then malignant. In addition to the increased risk of these long-term complications, the significant detrimental effects of heartburn on patients' daily activities and quality of life point to the need for more aggressive treatment with more powerful acid suppressants. The efficacy of PPI therapy is dependent on H+/K+ ATPase proton pump kinetics and the AUC of the PPI prescribed. Therefore, administration of a PPI before the first meal of the day is critical, as is careful selection of an agent that will control nocturnal heartburn.