This is a study that looked at quality of life and illness behavior of patients with reflux, either with or without esophagitis. When they looked at the quality of life alterations using both general wellness surveys and using disease-specific gastrointestinal surveys, people with esophagitis had no difference in illness behavior or alteration in quality of life compared to those without. Both of these were low, less than the norm, actually less than most illnesses except for severe chronic heart disease and psychiatric in-patients. A lot of reflux patients are measurable to have an altered quality of life, but endoscopy does not predict that. Also, the natural history of reflux disease without esophagitis gives us some questions of using endoscopy as a predictive factor on how people are going to do.
Acid suppression is the mainstay of treatment.
We made some changes in our statement, one by moving proton pump inhibitors above H2 blockers. I believe that they provide the most rapid symptom relief in the highest percentage of patients. H2 blockers still work in a lot of patients and they are effective in patients with less severe reflux disease. This is an important concept. I think that when you are walking all factors would indicate this to be a cost effective approach.