Assessment and treatment of refluxlike symptoms in the community: a multidisciplinary perspective

Heartburn and regurgitation are extremely common in Western societies, largely driven by obesity, age-related anatomical degradation of anti-reflux mechanisms, dietary, and psychological factors. Widespread diagnosis of gastro-oesophageal reflux disease (GORD) has led to liberal prescribing of proton pump inhibitors (PPIs) to ameliorate these symptoms. This strategy of first-line acid suppression is somewhat unsatisfactory for reflux-like symptoms for several reasons: 1) it equates all symptoms with a 'disease', regardless of their frequency, intensity, or potential morbidity; 2) it ignores symptom determinants other than acid reflux; and 3) it needlessly medicalises harmless symptoms compounding patient fear and hypervigilance, often reducing quality of life and driving healthcare utilisation.