General practice specialty training: an innovative programme.

British Journal of General Practice, October 2006 GORD than thinking about doing serial endoscopies. While effective acid suppression is likely to remain the cornerstone of therapy for GORD, non-pharmacological measures should always be considered, particularly as stopping smoking, reducing heavy drinking and addressing obesity have other self-evident health benefits. The role of non-drug factors in GORD has recently been reviewed and the evidence both for and against postural and dietary interventions is remarkably thin, although there is some support for raising the bedhead, avoiding post-prandial stooping, avoiding late evening meals and cutting out dietary provocants of various kinds. The most compelling evidence is that for the role of obesity, and of differences in the distribution of visceral and subcutaneous fat, which provides an obvious target for intervention. Finally, the role of psychological factors in the aetiology and exacerbation of reflux symptoms has not been extensively studied but in view of the health beliefs concerning heart disease and cancer held by many patients with upper gastrointestinal disorders probably deserves more attention. GORD imposes a significant health burden, because of its high prevalence, and has substantial adverse effects on patients’ lives. It is associated with significant morbidity and is a risk factor for increased mortality because of its aetiological link with adenocarcinoma of the oesophagus. Prescription of proton pump inhibitors accounts for around 15% of prescribing costs in general practice in the UK, making accurate diagnosis and appropriate management of particular importance. The new global definition of GORD provides valuable information to improve diagnostic precision and complements existing guidance on best practice.