GASTROESOPHAGEAL reflux disease (GERD) is one of the most common ailments in contemporary western society. Not only does it generate large spendings on over-the-counter medications, but it makes heavy demands on health care resources for diagnosis and treatment. The recent consensus document published in the Annals of Internal Medicine on March 11, 1996, 1 aims to summarize the views of a diverse group of experts about the optimal management of this common condition faced by the constraints imposed by the prevailing climate of managed care. The restrictions imposed by this fiscal environment include limitations in access to appropriate specialists, expensive testing for diagnostic and monitoring purposes, and long-term medications. More patients will have to be managed by their primary care physician on purely clinical grounds. The consensus document makes the important point that such restrictions tend to focus on short-term measures of outcome to determine if reducing expenditure on expensive testing and
Crookes PF, DeMeester TR. The Diagnosis and Treatment of Gastroesophageal Reflux Disease in a Managed Care Environment: A Surgeon's Response. Arch Surg. 1996;131(10):1021–1023. doi:10.1001/archsurg.1996.01430220015002
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