Managing chronic gastroesophageal reflux disease.

Evidence-Based Answer Proton pump inhibitors (PPIs) are superior to histamine H2 antagonists for treating chronic GERD. Comparisons among different PPIs or among different dosages and dosing regimens show few consistent differences. Limited studies suggest that continuous daily dosing provides improved symptom control and quality of life at six months compared with on-demand dosing. Surgery appears to be as effective as medication through up to three years of follow-up, but serious adverse effects may be more common with surgical treatments. Evidence to evaluate endoscopic treatments is lacking. (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)