A pragmatic symptom-based approach

Symptoms are the main cause of morbidity and a significant impairment of quality of life in reflux disease. The majority of patients report their symptoms to primary care physicians, and do not have objective evidence of reflux oesophagitis. Thus symptom evaluation is the primary method of diagnosis, assessment of severity, and determining the choice of therapy. Symptoms are not currently judged to cause reflux disease until they occur on at least two days a week; at this level, they lead to significant impairment of quality of life. Heartburn and regurgitation and general considered to be the cardinal symptoms of reflux. However, these often occur in the setting of other upper gastrointestinal symptoms, particularly epigastric pain, which patients often have difficulty in distinguishing from heartburn. Questionnaires have been developed in order to standardise and improve symptom-based diagnosis, and perform as well as primary care clinicians. These have yet to become mainstream practise but offer great potential.