Reflux of gastric content into the esophagus occurs in many circumstances in patients of all ages and can be categorized in many ways (Table 1). The symptoms of gastroesophageal reflux (GER) are variable and are broadly separated into “typical” or “atypical,” as shown in Table 2. The typical symptoms are readily associated with reflux of gastric contents, whereas the atypical symptoms are not so readily associated with gastroesophageal reflux disease (GERD).<sup>18 Fannin S.W., Falor W.H., Miler J.M. , e al. Gastroesophageal reflux into the proximal esophagus: Four-channel esophagopharyngeal pH study in normal and in symptomatic patients  Mt. Kisco, NY: Futura Publishing (1990).  63-71

Cliccare qui per andare alla sezione Riferimenti, 20 Gaynor E.B. Otolaryngologic manifestations of gastroesophageal reflux Am J Gastroenterol 1991 ;  86 : 801-808

Cliccare qui per andare alla sezione Riferimenti</sup> As the clinician begins to analyze foregut symptoms, therefore, a reflux problem must be considered in the differential diagnosis.

If GER occurs in the absence of other abnormalities, as it commonly does, the usual treatments have a high probability of success. When GER occurs secondary to problems such as pyloric stenosis, gastric atony, or other foregut abnormalities, treatment cannot be successful unless that problem is addressed. GER can also occur in conjunction with developmental abnormalities of the central nervous system, accounting for the majority of GER observed in pediatric patient populations.

In evaluating an individual patient, the anatomic, physiologic, and constitutional factors that might play a role should be evaluated in a systematic fashion. Although most GER patients do not have identifiable co-morbid conditions, failure to recognize the notable exceptions usually compromises the success of treatment. In addition, some conditions mimic GER's symptomatology (Table 2) but require totally different treatment; such patients do not respond to treatment directed against GER.<sup>10 Collective Report Discriminate value of esophageal symptoms: A study of the initial clinical findings in 499 patients with dysphagia of various causes Mayo Clinic Proc 1993 ;  68 : 1031-1033

Cliccare qui per andare alla sezione Riferimenti</sup>

This overview of “basic considerations” is relevant to physicians, surgeons, and administrators, all of whom face challenges in the evaluation and treatment of GER. Perhaps the greatest potential benefit will come to those in general practice or primary care, who are challenged as never before to be cost-effective, focused, and accurate in the diagnosis and staging of all foregut diseases, especially GER, which is the most common of these disorders. All physicians and health care systems should ideally have diagnostic and treatment algorithms for these problems, basing their choice of “required” tests on realistic expectations of success. Failure to properly evaluate patients ultimately, in my view, proves more costly and dangerous than the alternative presented here. It seems inherently obvious (but impossible to prove) that the most cost-effective approach is to properly evaluate patients before any protracted course of conservative treatment, or prior to surgical intervention.<sup>10 Collective Report Discriminate value of esophageal symptoms: A study of the initial clinical findings in 499 patients with dysphagia of various causes Mayo Clinic Proc 1993 ;  68 : 1031-1033

Cliccare qui per andare alla sezione Riferimenti, 11 Constantini M., Crookes P.F., Bremner R.M. , e al. Value of physiologic assessment of foregut symptoms in a surgical practice Surgery 1993 ;  114 : 780-786

Cliccare qui per andare alla sezione Riferimenti</sup>