To the Editor.——
I read with interest a recent article in the March issue of the ARCHIVES by Kitchin and Castell1 concerning the management of patients with gastroesophageal reflux. The Figure in this article shows the "iceberg" of gastroesophageal reflux disease. I believe this is an important concept that helps put the nature of the disease into perspective and emphasizes that the results of many recent clinical trials deal with only the most severe categories and may not be directly applicable to the average patient seen by the practicing physician. The primary citation for this concept should have been reference 2.
Graham DY. Categories of Patients With Gastroesophageal Reflux. Arch Intern Med. 1991;151(12):2476. doi:10.1001/archinte.1991.00400120108024