The second Canadian gastroesophageal reflux disease consensus: Moving forward to new concepts

Gastroesophageal reflux disease (GERD) is a disease with serious consequenc es that may result in significant impairment in quality of life and disease morbidity. Across all grades of severity of symptoms and severity of under lying esophageal disease, proton pump inhibitors (PPIs) provide therapeutic gains over prokinetics (PKs) or H-2 receptor antagonists (H2RAs). The pote ntial cost effectiveness of using medications with higher acquisition costs that may lower health care costs overall is often disregarded when conduct ing cost comparisons with medications having lower 'up-front' costs. Limiti ng therapy to less effective agents condemns many patients to protracted su ffering, repeated physician visits and needless reinvestigation of symptoms that could have been resolved by appropriate initial therapy. Based on cur rent data, use of any classification of symptom severity as a basis for sel ecting one class of therapeutic agents over another for first line therapy (ie PKs, H2RAs for 'mild' GERD, versus a PPI for 'severe' disease) is unwar ranted.