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Graham, once again, demonstrates his keen insight and perspective on clinical matters with the comments made in his letter. The large number of patients in our population who have troubling and frequent reflux symptoms are seen by primary care physicians. Yet, most clinical trials are performed in patients being evaluated in tertiary care centers after referral to consultant gastroenterologists. I totally agree with this concept and feel that it strongly supports the need to maintain a keen level of awareness of the potential importance of conservative therapies for reflux in these patients.
Castell DO. Categories of Patients With Gastroesophageal Reflux-Reply. Arch Intern Med. 1991;151(12):2476. doi:10.1001/archinte.1991.00400120108025