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This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.
A 53-year-old man, who is otherwise healthy and has a 20-year history of occasional heartburn, reports having had worsening heartburn for the past 12 months, with daily symptoms that disturb his sleep. He reports having had no dysphagia, gastrointestinal bleeding, or weight loss and in fact has recently gained 20 lb (9 kg). What would you advise regarding his evaluation and treatment?
The Clinical Problem
Strategies and Evidence
Diagnosis
Lifestyle Modifications
Medication
Surgery
Areas of Uncertainty
Guidelines from Professional Societies
Conclusions and Recommendations
Source Information
From the Division of Gastroenterology, Feinberg School of Medicine, Chicago.
An audio version of this article is available at www.nejm.org.
Address reprint requests to Dr. Kahrilas at the Feinberg School of Medicine, 676 St. Clair St., Suite 1400, Chicago, IL 60611-2951, or at p-kahrilas@northwestern.edu.
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