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Should patients with typical symptoms of gastroesophageal reflux disease (GERD) receive empirical treatment with proton-pump inhibitors or should they first undergo upper endoscopy and receive treatment based on the findings? Both approaches are common, but the better approach is hotly debated.
Italian investigators randomized 612 adults who had at least 3 months of GERD symptoms (heartburn with or without acid regurgitation) without alarm symptoms (e.g., involuntary weight loss, dysphagia, melena) to receive 4 weeks of empirical treatment with esomeprazole (40 mg once daily) or endoscopy-guided treatment (40-mg esomeprazole once daily for patients with reflux esophagitis or 20 mg once daily for those without esophagitis). Both treatment str…