***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND & AIMS Gastroesophageal reflux is considered a common condition , but detailed population -based data on reflux in the United States are lacking . The aim of this study was to determine the prevalence and clinical spectrum of  gastroesophageal reflux in Olmsted County , Minnesota . METHODS A reliable and valid self-report question naire was mailed to an age- and sex-stratified r and om sample of 2200 Olmsted County residents aged 25 - 74 years . RESULTS The prevalence per 100 of heartburn and /or acid regurgitation experienced at least weekly was 19.8 ( 95 % confidence interval [ 95 % CI ] , 17.7 - 21.9 ) . Heartburn and acid regurgitation were associated with noncardiac chest pain ( odds ratio [ OR ] , 4.2 ; 95 % CI , 2.9 - 6.0 ) , dysphagia ( OR , 4.7 ; 95 % CI , 2.9 - 7.4 ) , dyspepsia ( OR , 3.1 ; 95 % CI , 1.9 - 5.0 ) , and globus sensation ( OR , 1.9 ; 95 % CI , 1.0 - 3.6 ) but not with asthma , hoarseness , bronchitis , or a history of pneumonia . Among subjects with reflux symptoms , 1.0 % reported an episode of hematemesis and 1.3 % had a past esophageal dilatation . CONCLUSIONS Symptoms of reflux are common among white men and women who are 25 - 74 years of age . Heartburn and acid regurgitation are significantly associated with chest pain , dysphagia , dyspepsia , and globus sensation . The percentage of patients reporting complications is low , but the absolute number is probably considerable given the high prevalence of the condition in the community Symptoms suggestive of gastro-oesophageal reflux disease are very common . The aim of the study was to assess the prevalence of these symptoms and factors influencing them in an unselected adult population . A question naire was mailed to a r and om sample of 2500 people aged > or = 20 years . The questions concerned heartburn , regurgitation , dysphagia , chest and upper abdominal pain , as well as medication and medical consultations for these symptoms . Of the 1700 ( 68 % ) responders , 9 % had experienced heartburn on the day of response and 15 % , 21 % and 27 % during the preceding week , month and year , respectively . The corresponding figures for regurgitation were 5 , 15 , 29 and 45 % . During the past year 43 % of the study group had had no such symptoms . Age , overweight , pregnancy and cigarette smoking significantly influenced the prevalence of symptoms . Using daily heartburn and /or regurgitation as dominant indicators 10.3 % ( 95 % CI 12 - 11.7 ) of the responders had gastro-oesophageal reflux disease .  Medication ( most commonly antacids ) was used by only 16 % of the symptomatic people , and only 5.5 % had sought medical advice for symptoms during the past year . Thus , despite commonness of symptoms suggestive of gastro-oesophageal reflux disease only a minority of the individuals suffering from such symptoms use medication or have medical consultation This article presents the relevance of norm values to a battery of Quality of Life question naires for use in upper gastrointestinal disorders . The derivation of reference values offers an important contribution by confirming the ability of the question naires to differentiate patients from healthy controls . Two self-administered question naires , the Psychological General Well-being ( PGWB )  index and the Gastrointestinal Symptom Rating Scale ( GSRS )  were used . The norm values were derived in a r and omly selected sample from a Swedish population consisting of 4624 individuals ( reference group ) . The patients comprised more than 900 patients with gastroesophageal reflux disease ( GORD ) included in clinical trials . In the reference group , males reported significantly higher values on well-being as compared with women , whereas women reported more pronounced gastrointestinal symptoms than men . Generally , the younger persons and the group aged 60 - 70 years reported the highest well-being . Among gastrointestinal patients women scored lower and reported more symptoms than men . With increasing age , well-being improved and symptoms declined . Even though the well-being and symptoms scores differed between patient and the reference group similar patterns in terms of age and gender were observed . In summary , the results show that there are differences with respect to gender and age among normal controls as well as in GORD patients . These aspects have to be considered in clinical studies . The results also support the discriminative ability of the Quality of Life instruments BACKGROUND The first step in the management of uncomplicated dyspepsia in primary care often consists of prescribing empirical therapy , but in certain cases prompt endoscopy might be preferred . Any decision is usually based on the patient 's symptoms and the presumed underlying pathology that causes these symptoms . AIM To assess the relationship between symptom subgroups and the effect of management strategies on primary care patients with dyspepsia . DESIGN OF STUDY R and omised controlled trial . SETTING All patients presenting successively with a new episode of dyspepsia between January 1995 and November 1997 . METHOD The results of four management strategies in dyspeptic primary care patients were compared and the value of subgrouping within this trial was estimated . Patients were allocated to one of either ( a ) empirical treatment in which therapy was based on the presented symptoms , or empirical treatment with ( b ) omeprazole or ( c ) cisapride regardless of the presented symptoms , or ( d ) prompt endoscopy followed by the appropriate treatment . Patients were retrospectively classified into the subgroups for each strategy using baseline data . The yield of each strategy was measured by counting the number of strategy failures in the first year . RESULTS Of the 349 included patients , 326 were analysed . No statistically significant difference could be demonstrated between the strategies or between the symptom subgroups . However , patients in the reflux-like subgroup showed a trend towards a better outcome in all empirical strategies . Ulcer-like dyspepsia seemed to benefit from omeprazole . The non-specific subgroup seemed to benefit from cisapride but also had the highest proportion of strategy failure . Prompt endoscopy did not appear especially useful in any subgroup . CONCLUSION Although this study has relatively low power , we conclude that the use of symptom subgroups seems to be a sensible approach when choosing empirical therapy in dyspepsia . Patients with reflux-like symptoms seem to have the best prognosis in the first year in every strategy A postal question naire on heartburn sent to 6760 r and omly selected subjects yielded 3971 replies suitable for analysis . Heartburn had never been experienced by 1665 ( 42 % ) respondents . Significant symptoms of more than three months ' duration that had occurred at least once a month in the preceding 12 months were reported by 1337 ( 34 % ) respondents . Of these , 875 had not consulted their general practitioner and were invited to attend for a structured interview with question naire and upper gastrointestinal endoscopy . A total of 177 were interviewed , and 143 underwent upper gastrointestinal endoscopy .  Of those endoscoped , 106 ( 74 % ) experienced symptoms at least once a week . These were relieved by alginate consumption in 97 ( 68 % of ) cases . Just nine ( 6 % ) patients had been taking H2-receptor antagonists .  Macroscopic appearances of oesophagitis were seen in 46 cases [ 13 ( 6 % ) grade 1 , 24 ( 11 % ) grade 2 , five ( 2 % ) grade 3 , two ( 1 % ) grade 4 , and two ( 1 % ) grade 5 ] . Three patients had mild strictures and six patients had Barrett 's oesophagus . There were no appearances suggestive of malignancy . Biopsies were taken in 122 cases , including all those in which abnormalities had been seen . Histological evidence of oesophagitis was seen in 47 cases . Gastric metaplasia was found in six cases and dysplasia seen in three . Patients who self-medicate for reflux symptoms have a low prevalence of pre-neoplastic and neoplastic pathology . A substantial proportion , however , have histological evidence of oesophagitis and a small number have metaplasia The healing effect of the prokinetic drug cisapride ( 10 mg q.i.d . ) on esophageal lesions , and its therapeutic control of gastroesophageal reflux symptoms were compared with the effects of the H2-antagonist ranitidine ( 150 mg b.i.d . + placebo b.i.d . ) in a double-blind trial . In each group , 28 patients with Savary-Miller Grade I or II esophagitis were treated for 6 or 12 weeks . At the end of treatment , follow-up endoscopy showed that mucosal lesions were absent in 89 % of the cisapride patients and in 79 % of the ranitidine patients . In addition , 86 % and 82 % of the patients in the cisapride and the ranitidine group , respectively , had no , or only mild , reflux symptoms . Minor side effects were experienced in both groups . From these data , cisapride appears to be as effective as ranitidine in controlling reflux symptoms and in promoting the healing of mucosal lesions in milder forms of reflux esophagitis 
    Output:
    
PPIs are more effective than H2RAs in relieving heartburn in patients with GORD who are treated empirically and in those with ENRD , although the magnitude of benefit is greater for those treated empirically