In r.:Ltt 11>n lll the first :1 rea, four i,sue, were cli,cu,sed: def in i rH m of d iscasc• sL•,•eri t y; method, of i nve,t iga unn; rel at 1 ,•e i mp"rt ance pf acid 11ml mot ii 11 y in I he p,ll h,,genesb nf t , ERD; and compl1cnt 11m,. Re.tlarding rhe approach t11 therapy, r; ,ur .1rea, were considered: thernpy with lifl',ry le mL,d i!'icatiun and 1111ual therapy; ma intenance ther:ip\; and med1rn l ven,us surgical thernpy, inc luding tre,llment nf cnmpl1cnt1uns. fa1ch sectl,lll 1,•as 111tnllluceLl 111 1he L'ntire group of pmtic1panls hy prep:1red Laib ,111 background informat ion. Thi, was followed hy ,li,cu. ,,i,111 111 , mall grnup, nf '<'Ven tn 12 particip,mls each. Th e ~1rn1 II group ,css1nns WL're then , ummnrized hy I he sl'ss1, > n Ch,11 rp,•rson, :111d werl' pre,1'111ed h 11• f urthcr di ,c ussinn 111 I he entire g r,1up ,1f 40 p.irtic1p,111t,. The C'hairper,l1n I hen prep.ired a written summary ot the gr,1t1p cli,cw,,wn.Agreemem was re:1chcd 111 mn,1 .irea~ and a , uggested decis1nn tree for 1hc mnnagemem of patients wnh ,;i Rn 11•ns develnpcd: the maJnrit)' ol persim, wit h UFRI) symptoms have mild gn,1r,>e"1ph:1geal reflux d1,e,1se; mnst penple with (i~Rll d,, nnt ,cc ;1 ph ys1c1an, ,md 111l1St ck, wdl o n se lf-admini-,tercd Pver-t he-counter therapy. When the per~nn pre,ems to his/her fom ily physicim1 , the• suggested 111nial lre,11111ent lnr .,\mpwmnu, (,FRI) sh11lild i,:un,1,1 uf li fe,1yle mL,dificauon, m•er-thecnuntertherapy an,l l lz-hlocl..er,. Pr, ,kinetic:, a, initi:1 l 1reat me11t .,h uu Id he used only undcr ,peci,il cund it i1,n,. Prohahly about 1wn persnns in three will improve nn lik,tyle modifkat1on , ,11•er-rhe -cnu111L'r rherapy and H~-hlnckers. If the patient with symptoms l,f l,LRLhloe, nm respond 111 1 h 1, iniri,11 f,>ur weight weeb nf therapy, rhe phy, ician has to , u, pecl the presence ol 1rn,re ,erinus d ise,1sc such ,1, en1s1ve esnphag1us, e,uphag1us wi1 h c, 1111pl 1 cat 1nns, ,ir disease nth,•r th,111 ( ,ERi). Therefore, he fore suming protnn pum11 111hihit,w,. endu,cllp\ b in,licatcd. Di.1gnostic m, ,1il11 y stud ies ( 24 h pH and/or mmilit\' and Bernstein test) arc needed on ly under special condit111m. < 11 Rll 1 ., a c: hn,nic relap, 111g disea,e and frequentl y maintenance therapy is needed, p:irritularly when the p.itienr ha, hnd endosCL1pica lly-proven eru, ive esophagi ti,. Mnin1 enrince therapy , hould he undcrrnken with the least pot ent drug thai prevents relapse. T1, dare, 111 severe disease the hest dma fnr maimenance therapy would favnur the ust' of a prown pump 111h1h1tnr nl'er , rnndard duses of an l lz-h lncker, but h igher do,c,, ,lf H2-blocker therapy m,1y pnwc to lw u,eful in :.ome pat ien1s. Most pat ient, with UER ll (even those with complications) can he managed medically, hut there :ire ,urg1cal indic.11i,1n, Ill he con,idered in individual pati..:nu,. A 'Decision Tree' for rhe suggested management of p,llienb with t 1FIUl wa, devcl,,ped t,, facdira1e t hL• clinical approach to this common clinical ...

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