Comparison of Medical and Surgical Therapy for Complicated Gastroesophageal Reflux Disease in Veterans

APPROXIMATELY 40 percent of adult Americans have heartburn, the cardinal symptom of gastroesophageal reflux disease, at least once each month. 1 Among patients who seek medical attention for symptoms of reflux esophagitis, 10 to 20 percent have serious complications such as esophageal stricture or Barrett's esophagus. 2 3 4 The conventional medical treatment of reflux disease usually begins with modifications of lifestyle that are aimed at minimizing gastroesophageal reflux, and often involves combination drug therapy. 5 , 6 Studies of reflux disease have been limited primarily to short-term observations of the effects of individual drugs, with little or no emphasis on lifestyle modifications. 5 Most patients with reflux . . .