Treatment strategies for acid reflux: EncomPASSing practical solutions for primary care

Despite a steady diet of randomized controlled trials (RCTs) for over three decades, nearly all of our routine clinical decisions remain incompletely supported, or even totally unaddressed, by the burgeoning pile of RCT data. The biomedical literature tends to focus on explanatory RCTs that compare new agents with placebo; it is less common to find pragmatic clinical trials (PCTs) that test the risks, benefits, and costs of competing active therapies within the context of usual practice settings. In this issue of the American Journal of Gastroenterology, Moayeddi and colleagues report the results of the EncomPASS study-a novel PCT for the primary care management of reflux disease. In this editorial, the results of EncomPASS are discussed, and the study is highlighted as a model for investigators to follow as we continue to emphasize pragmatic trials that address everyday challenges in clinical care.