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Review
. 2008 May;54(5):701-5.

Approach to gastroesophageal reflux disease in primary care: Putting the Montreal definition into practice

Nigel Flook  1 , Roger Jones, Nimish Vakil
Affiliations
Review

Approach to gastroesophageal reflux disease in primary care: Putting the Montreal definition into practice

Nigel Flook et al. Can Fam Physician. 2008 May.

Abstract
in English, French

Objective: To apply the recently published Montreal definition of gastroesophageal reflux disease (GERD) in primary care.

Sources of information: The Montreal definition of GERD was developed by an international consensus group of experts in GERD and primary care physicians using rigorous evidence-based methods along with modern consensus development techniques and a patient-centred approach.

Main message: Gastroesophageal reflux disease can be diagnosed in primarycare based on symptoms alone without additional diagnostic testing. Symptoms reach a threshold where they constitute disease when they are troublesome (cause difficulty) to patients. In addition to the cardinal symptoms of heartburn and regurgitation, people with GERD can also have sleep disturbances, chest pains, or respiratory symptoms. Monitoring patients' response to proton pump inhibitor therapy can confirm the success of management. Treatment for symptoms of GERD can also heal underlying reflux esophagitis if it is present.

Conclusion: Primary care physicians can diagnose and manage GERD confidently in most patients by investigating and treating troublesome symptoms without the need for additional investigations or referral to specialists.

OBJECTIF: Mettre en pratique dans les soins primaires la définition de Montréal du reflux gastro-œsophagien (RGO) récemment publiée.

SOURCES DE L’INFORMATION: La définition de Montréal du RGO a été développée par un groupe de spécialistes du RGO et de médecins de première ligne internationaux réunis pour faire des recommandations, grâce à des méthodes fondées sur des preuves rigoureuses et à des techniques modernes de développement de consensus, et en adoptant une approche centrée sur le patient.

PRINCIPAL MESSAGE: On peut diagnostiquer le reflux gastro-œsophagien en médecine primaire à partir des seuls symptômes, sans test diagnostique additionnel. C’est lorsque les symptômes deviennent gênants pour la patient qu’on peut parler de maladie. Outre les symptômes cardinaux de pyrosis et de régurgitation, on peut aussi observer des troubles du sommeil, douleurs thoraciques ou symptômes respiratoires. L’observation de la réponse aux inhibiteurs de la pompe à protons peut confirmer le succès du traitement. Le traitement des symptômes du RGO peut aussi guérir une œsophagite de reflux sous-jacente.

CONCLUSION: Le médecin de première ligne peut diagnostiquer et traiter sans crainte la plupart des cas de RGO en investiguant et en traitant les symptômes incommodants sans recourir à des examens additionnels ou à des spécialistes.

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Figures

Figure 1
Figure 1. The Montreal definition of gastroesophageal reflux disease and its constituent syndromes
Gastroesophageal reflux disease is a condition that develops when the reflux of gastric content causes troublesome symptoms or complications.
See this image and copyright information in PMC

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