Introduction

According to the Montreal definition, gastro-oesophageal reflux disease (GORD) is a condition that develops when reflux of the stomach contents into the oesophagus causes troublesome symptoms and/or complications.1 GORD is a chronic disorder which impacts health related quality of life (HR-QOL) and reduces work productivity.2,–,4 During the past two decades, the superiority of proton pump inhibitors (PPIs) over other drugs (antacids, prokinetics and H₂ receptor antagonists) has been established beyond doubt and PPIs are now considered as the mainstay of antireflux medical therapy.5 6 However, once healing of mucosal breaks and sufficient symptom relief have been achieved by initial therapy, the main goals of long term management are to maintain symptom control and prevent lesion recurrence, allowing a return to a nearly normal quality of life. Maintenance treatment with a PPI may be an option, offering high rates of symptom resolution and healing of oesophagitis.6 However, some patients are reluctant to take long term medication and may prefer to have antireflux surgery which has also be revolutionised by the development of the laparoscopic route. In this debate, we will discuss the advantages/inconvenience of both long term strategies—that is, drugs versus surgery. Our purpose is not to oppose treatments but rather to help the clinician and especially the primary care doctor who has the opportunity of making a major difference by the correct choice of treatment and investigations.