***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND & AIMS Dysphagia is considered an alarm symptom , raising the question of stricture or malignancy . We sought to determine the prevalence and severity of dysphagia in patients with uncomplicated erosive esophagitis and its response to therapy . METHODS A total of 11,945 patients with endoscopically confirmed erosive esophagitis ( Los Angeles grade s A-D ) participated in 5 double-blind , r and omized , clinical trials evaluating the efficacy of up to 8 weeks of treatment with either once-daily esomeprazole 40 mg ( n = 5068 ) , esomeprazole 20 mg ( n = 1243 ) , omeprazole 20 mg ( n = 3018 ) , or lansoprazole 30 mg ( n = 2616 ) . The severity of dysphagia ( 4-point scale ) was rated at baseline and at week 4 . Esophagitis was classified as mild ( grade A or B ) or severe ( grade C or D ) . RESULTS At baseline , 4449 of 11,945 patients ( 37 % ) had dysphagia-43 % of patients with severe esophagitis , and 35 % of patients with mild esophagitis ( odds ratio , 1.39 ; 95 % confidence interval , 1.27 - 1.51 , P < 0.001 ) . Dysphagia resolved in 83 % of patients after 4 weeks of proton pump inhibitor ( PPI ) treatment . Resolution of dysphagia was associated with a mean healing rate of 90 % across all treatments . Seventeen percent of patients reported persistent dysphagia , and in these patients the healing rates were decreased significantly ( mean 72 % ; P < 0.0001 ) . CONCLUSIONS Dysphagia is common in patients with erosive esophagitis but is not a reliable clinical predictor of severe erosive esophagitis . Dysphagia resolved with PPI therapy in most cases , but persistent dysphagia may indicate failed healing BACKGROUND & AIMS The incidence of esophageal adenocarcinoma in the western world has been linked to chronic heartburn , regurgitation , and the development of the premalignant epithelium of Barrett 's esophagus ( BE ) . However , up to 40 % of esophageal adenocarcinomas occur in patients without prior reflux symptoms . We prospect ively screened for the presence of BE in asymptomatic subjects older than 50 years of age undergoing screening sigmoidoscopy for colorectal cancer . METHODS Subjects undergoing sigmoidoscopy for colorectal cancer ( CRC ) screening were invited to  undergo upper endoscopy .  Exclusion criteria included symptoms of gastroesophageal reflux disease ( GERD ) more than once a month , use of medications for GERD , or previous endoscopy . BE was classified as long-segment BE ( LSBE ) , short-segment BE ( SSBE ) , and microscopic specialized intestinal metaplasia of the esophagogastric junction ( SIM-EGJ ) . RESULTS Of 408 potential study c and i date s , 110 subjects were screened ; 9 were women . The mean ( + /-SD ) age was 61 + /- 9.3 ( range , 50 - 80 ) years , most of them ( 73 % ) Caucasian .  Intestinal metaplasia ( IM ) extending above the EGJ was detected in 27 ( 25 % ) subjects ; 8 ( 7 % ) had LSBE , and 19 ( 17 % ) had SSBE . Patients with BE were no more likely to be obese , consumers of tobacco or alcohol , report a family history of GERD , show association with toxic exposure , or use antacids more than once a month , compared with those without BE . CONCLUSIONS BE was detected in 25 % of asymptomatic male veterans older than 50 years of age undergoing screening sigmoidoscopy for CRC We prospect ively evaluated the value of histology in identifying  gastroesophageal reflux disease ( GERD ) in consecutive patients enrolled for upper endoscopy . GERD was defined as heartburn occurring at least weekly . Macroscopic esophagitis was grade d and an esophageal biopsy was taken 2 cm above the gastroesophageal junction . Histological esophagitis was identified by : ( 1 ) basal cell hyperplasia > 15 % , ( 2 ) increased papillary length > 66 % , and ( 3 ) infiltration by leukocytes/eosinophils . The sensitivity , specificity , and positive and negative predictive value of histological esophagitis in patients with and without typical reflux symptoms , with and without endoscopic changes , or both were evaluated . Of 178 patients , reflux symptoms were present in 59 % ( N = 105 ) and esophageal erosions in 19 % ( N = 34 ) ; 75 patients had reflux symptoms  but no erosions . While the specificity of histology was adequate ( 78 % ) , it was insensitive ( 30 % ) . The positive and negative predictive values were 67 % and 44 % , respectively . No single individual parameter was better than any other . Thus , histology appears to be of no additional value in identifying GERD OBJECTIVES To describe the prevalence of Rose angina and non-exertional chest pain in men and women in socioeconomically contrasting areas ; to describe the proportions of men and women who present with the symptom of chest pain and who receive a provisional general practitioner diagnosis of coronary heart disease ; to assess the effects of gender and deprivation . DESIGN Two r and om general population sample s in socially contrasting areas were surveyed using the Rose angina question naire : the case notes of people identified with chest pain were review ed . SETTING Glasgow conurbation . PARTICIPANTS 1107 men and women , aged 45 - 64 , with chest pain . OUTCOME MEASURES Prevalence of Rose angina and non-exertional chest pain ; the proportions who had presented with chest pain and received a general practitioner 's provisional diagnosis of coronary heart disease . RESULTS There was no difference between social groups in the prevalence of all chest pain but a greater proportion of those in deprived groups had Rose angina and a greater proportion of these had the more severe grade . The proportion of people who had presented with chest pain was higher among socioeconomically deprived groups but there was no difference in the proportions receiving a general practitioner provisional diagnosis of coronary heart disease . Men were more likely to present with chest pain than women and were more likely to receive a provisional general practitioner diagnosis of coronary heart disease . CONCLUSIONS No evidence was found of social differences in patient presentation or general practitioner diagnosis that might explain reported variations in uptake of cardiology services . In contrast , gender variation may originate in part from differences in patient presentation and general practitioner diagnosis . Further investigation of socioeconomic variations in uptake of cardiology services should focus later in the care pathway , on general practitioner referral patterns and clinical decisions taken in secondary care Background : The optimal management of patients with reflux-associated laryngitis is unclear . We performed a placebo-controlled crossover trial in patients with proven reflux disease and associated laryngitis to determine the effect of pantoprazole and to gain information on the natural course of the disease . Methods : Sixty-two consecutive non-smoking patients with hoarseness and proven laryngitis were examined .  Scores with respect to the larynx and for subjective complaints were determined and 24-h pH-metry to assess acid reflux in the lower oesophagus and pharynx was performed . Patients with pathologic reflux were given the chance to enter a double-blinded r and omized crossover trial with pantoprazole 40 mg b.i.d . and placebo for a duration of 3 months each , separated by a 2-week washout period . Results : Twenty-four of 62 patients showed pathological reflux ; 21 patients were included in the study and 14 concluded all parts of the study . Both pantoprazole and placebo result ed in a marked improvement in laryngitis scores ( decrease of 8.0 ± 1.4 versus 5.6 ± 2.6 ; no significant difference between the 2 treatments ) and symptoms after the first 3 months ( decrease of oesophageal symptom score of 2.2 ± 1.4 versus 5.4 ± 2.8 ; decrease of laryngeal scores of 8.3 ± 3.6 versus 10.3 ± 3.9 ; also no significant difference between the 2 treatments ) . A second pH-metry 2 weeks thereafter proved the persistence of reflux in most of these patients . Switching to pantoprazole led to a further improvement of scores . In the group switched to placebo there was recurrence only in a minority of patients . Conclusions : The self-limited nature of reflux-associated laryngitis in non-smokers is largely underestimated . Laryngitis improves despite the persistence of reflux . Pantoprazole may be helpful especially in relieving acute symptoms , but the advantage of long-term treatment over placebo has been greatly overestimated Forty eight patients with moderate to severe asthma were enrolled in a double blind crossover study design ed to evaluate the effects of ranitidine treatment , 150 mg twice daily for four weeks , on gastro-oesophageal reflux , asthma control , and bronchial reactivity .  All 48 had a history of reflux symptoms and 27 had in addition reflux associated respiratory symptoms . Thirty two patients had objective evidence of acid reflux on 24 hour pH monitoring ( pH of less than 4 for more than 1 % of the 24 hours ) and 27 patients had a positive result in the acid perfusion test . Reflux symptoms were significantly improved after ranitidine treatment . Ranitidine treatment was associated with modest improvements in nocturnal asthma and daily use of inhaled bronchodilator drugs but there was no significant change in bronchial reactivity , lung function , peak flow , or the number of eosinophils in the blood . Comparisons between the effect of ranitidine treatment on asthma control were performed between patients with and without a history of reflux associated respiratory symptoms , with and without a positive result in the acid perfusion test , and with and without objective evidence of gastro-oesophageal reflux . A history of reflux associated respiratory symptoms was the only factor that predicted an improvement in asthma control after ranitidine treatment . These results indicate that antireflux treatment will produce only small improvements in asthma control in asthmatic patients with a history of gastro-oesophageal reflux BACKGROUND Two types of reflux episodes have been identified : upright or daytime and supine or nocturnal . The population -based prevalence of symptoms of nocturnal gastroesophageal reflux disease ( GERD ) and the impact of those symptoms on health-related quality of life ( HRQL ) have not been established . METHODS A national r and om- sample telephone survey was conducted to estimate the prevalence of frequent GERD and nocturnal GERD-like symptoms and to assess the relationship between HRQL , GERD , and nocturnal GERD symptoms .  Respondents were classified as controls , subjects with symptomatic nonnocturnal GERD , and subjects with symptomatic nocturnal GERD .  The HRQL was assessed using the Medical Outcomes Study Short-Form 36 Health Survey ( SF-36 ) . RESULTS The prevalence of frequent GERD was 14 % , with an overall prevalence of nocturnal GERD of 10 % . Seventy-four percent of those with frequent GERD symptoms reported nocturnal GERD symptoms .  Subjects with nonnocturnal GERD had significant decrements on the SF-36 physical and mental component summary scores compared with the US general population . Subjects reporting nocturnal GERD symptoms were significantly more impaired than subjects reporting nonnocturnal GERD symptoms on both the physical component summary ( 38.94 vs 41 . 52 ; P<.001 ) and mental component summary ( 46.78 vs 49.51 ; P<.001 ) and all 8 subscales of the SF-36 ( P<.001 ) . Subjects with nocturnal GERD demonstrated considerable impairment compared with the US general population and chronic disease population s. Subjects with nocturnal GERD had significantly more pain than those with hypertension and diabetes ( P<.001 ) and similar pain compared with those with angina and congestive heart failure . CONCLUSIONS Nocturnal symptoms are commonly experienced by individuals who report frequent GERD symptoms . In addition , HRQL is significantly impaired in those persons who report frequent GERD symptoms , and HRQL impairment is exacerbated in those who report nocturnal GERD symptoms OBJECTIVE : Previous uncontrolled studies suggested a therapeutic benefit for treating gastroesophageal reflux disease ( GERD ) among patients with laryngitis . The present study is the first r and omized , placebo-controlled , double-blind study of gastric acid suppression among patients with laryngitis in the United States . METHODS : Patients diagnosed with idiopathic chronic laryngitis were r and omized to receive either lansoprazole 30 mg p.o . b.i.d . or a matching placebo for 3 months . Before r and omization , all patients underwent 
    Output:
    
: Evidence -based global consensus definitions are possible despite differences in terminology and language , prevalence , and manifestations of the disease in different countries .