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Canadian Journal of Gastroenterology
Volume 12, Issue 8, Pages 551-556

The Second Canadian Gastroesophageal Reflux Disease Consensus: Moving Forward to New Concepts

ABR Thomson,1 N Chiba,2 D Armstrong,3 G Tougas,3 and RH Hunt3

1Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
2Surrey GI Clinic, Guelph and McMaster University, Hamilton, Ontario, Canada
3Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada

Received 9 July 1998; Accepted 14 July 1998

Copyright © 1998 Canadian Association of Gastroenterology. This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (, which permits reuse, distribution, and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes.


Gastroesophageal reflux disease (GERD) is a disease with serious consequences that may result in significant impairment in quality of life and disease morbidity. Across all grades of severity of symptoms and severity of underlying esophageal disease, proton pump inhibitors (PPIs) provide therapeutic gains over prokinetics (PKs) or H2 receptor antagonists (H2RAs). The potential cost effectiveness of using medications with higher acquisition costs that may lower health care costs overall is often disregarded when conducting cost comparisons with medications having lower 'up-front' costs. Limiting therapy to less effective agents condemns many patients to protracted suffering, repeated physician visits and needless reinvestigation of symptoms that could have been resolved by appropriate initial therapy. Based on current data, use of any classification of symptom severity as a basis for selecting one class of therapeutic agents over another for first line therapy (ie PKs, H2RAs for 'mild' GERD, versus a PPI for 'severe' disease) is unwarranted.