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The clinical picture of the gastroesophageal reflux disease (GERD) is usually rather simple and composed by heartburn and/or regurgitation (typical manifestations). However atypical manifestations (cough, chronic laringeal symptoms, asthma, etc) may also be the complaint. GERD may be erosive (erosions in the upper endoscopy) or non-erosive (endoscopy negative). The findings of the physical examination are in general poor but obesity should be remembered as an important aggravating feature of reflux.The more important subsidiary examination for detecting all kinds os reflux is the 24h impedance-pHmetry which is not frequently used because in the majority of cases the diagnosis is established based upon the clinical history. The clinical treatment is based in clinical/behaviour measures and pharmacological approach. The clinical/ behaviour measures include the raising the head of the bed, loosing weight, avoid fat foods, etc. The current pharmacological approach is based upon the use of the proton pump inhibitors (PPI) initially in standard dosis (omeprazole, lansoprazole, pantoprazole, rabeprazole and esomeprazole). The principal surgical indications are the complications of the disease (ex. stenosis, ulcers) and the patients who require long term continuous maintenance treatment. Usually the best responders to the surgical treatment are the best responders to the medical IBP treatment.

Moreira JR Editora