***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 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 OBJECTIVES To evaluate complete symptom resolution , mucosal healing , and tolerability of omeprazole , ranitidine , or ranitidine/metoclopramide in patients with poorly responsive , symptomatic gastroesophageal reflux disease ( GERD ) . METHODS Adults with persistent symptomatic GERD after ranitidine treatment were stratified by esophagitis grade and r and omized to omeprazole 20 mg once daily , ranitidine HCI 150 mg twice daily , or ranitidine HCI 150 mg twice daily plus metoclopramide HCI 10 mg four times daily . Endoscopies were conducted at baseline and at wk 4 and 8 . Patients assessed overall symptom improvement at wk 4 and 8 and evaluated daytime and nighttime heartburn , dysphagia , and acid regurgitation daily . RESULTS After 1 wk , 13 % of patients receiving omeprazole ( N = 100 ) had complete resolution of all GERD symptoms versus 1 % and 3 % of patients receiving ranitidine ( N = 97 ) or ranitidine/metoclopramide ( N = 93 ) , respectively ( p < 0.001 ) . More patients receiving omeprazole had complete symptom resolution at wk 4 ( 33 % ) and at the end of the study ( 64 % ; both p < 0.001 ) than patients receiving ranitidine ( 8 % and 28 % , respectively ) or ranitidine/metoclopramide ( 7 % and 29 % , respectively ) . Regardless of baseline esophagitis grade , more patients receiving omeprazole had complete symptom resolution . At wk 8 , more than 91 % of patients with grade 0 or 1 esophagitis at baseline were still healed irrespective of treatment . At wk 8 , 80 % of patients with esophagitis grade 2 or higher at entry were healed with omeprazole ( p < 0.001 vs ranitidine [ 40 % ] and ranitidine/metoclopramide [ 46 % ] ) . Thirty-four percent of patients reported an adverse event . Significantly more patients receiving combination treatment reported an adverse event than patients treated with single agents . CONCLUSIONS In patients with persistent GERD symptoms after ranitidine , omeprazole ( 20 mg daily for up to 8 wk ) provides faster and more complete resolution of common GERD symptoms than continued ranitidine ( 300 mg daily ) alone or in combination with metoclopramide ( 40 mg daily ) . Omeprazole provides significantly higher rates of endoscopic healing than ranitidine alone or with metoclopramide . Omeprazole and ranitidine are generally well tolerated . The addition of metoclopramide to ranitidine significantly increases adverse events BACKGROUND Up to three quarters of patients with gastroesophageal reflux disease ( GERD ) have symptoms , such as heartburn , but no macroscopic evidence of erosive esophagitis , making symptomatic GERD a common clinical problem in the primary care setting . OBJECTIVE To compare the efficacy and safety of omeprazole , 20 mg once daily ; omeprazole , 10 mg once daily ; and placebo in the treatment of symptomatic GERD without erosive esophagitis . METHODS Patients with a history of heartburn ( > or = 12 months ) and episodes of moderate to severe heartburn on 4 or more of the 7 days before endoscopy were eligible to participate in this 4-week , r and omized , double-blind , placebo-controlled trial . The absence of erosive esophagitis was established through endoscopy . Eligible patients were r and omized to 1 of 3 treatment groups : omeprazole , 20 mg once daily ; omeprazole , 10 mg once daily ; or placebo . Patients were assessed at weeks 2 and 4 . The efficacy of omeprazole for the treatment of heartburn was determined mainly through the following diary card data : daily resolution of heartburn and complete resolution of heartburn every day during 1 week of treatment . The efficacy of omeprazole for the treatment of acid regurgitation , dysphagia , epigastric pain , and nausea was also assessed . RESULTS Of 359 r and omized patients , 355 were included in the statistical analysis ( intention-to-treat population ) . Daily proportions of patients with no heartburn were consistently greater in the 20-mg omeprazole group ( 62 % , day 7 ; 74 % , day 27 ) than in the 10-mg omeprazole group ( 41 % , day 7 ; 49 % , day 27 ) or the placebo group ( 14 % , day 7 ; 23 % ; day 27 ) . Complete resolution of heartburn every day during the last treatment week was significantly ( P < or = .002 ) higher in the 20-mg omeprazole group ( 48 % ) than in the 10-mg omeprazole ( 27 % ) or placebo ( 5 % ) group . Omeprazole was significantly ( P < or = .003 ) more effective than placebo for the treatment of acid regurgitation , dysphagia , epigastric pain , and nausea . CONCLUSIONS Patients with symptomatic GERD require profound acid suppression to achieve symptomatic relief . Omeprazole , 20 mg once daily , was superior to omeprazole , 10 mg once daily , and to placebo in providing early and sustained resolution of heartburn , as well as treatment of other troublesome GERD symptoms 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 Objective : We evaluated the efficacy and safety of a twice-daily dosage regimen of cisapride 20 mg in relieving the symptoms of mild-moderate gastroesophageal reflux disease ( GERD ) in patients with moderate intensity heartburn and no history of erosive esophagitis . Methods : After a 2-wk , single-blind , placebo run-in period , 398 patients who continued to experience moderate intensity heartburn were r and omized to either placebo ( n = 196 ) or cisapride 20 mg ( n = 202 ) twice daily for 4 wk . Results : Compared with placebo , cisapride significantly reduced scores for daytime and nighttime heartburn ( p < 0.001 ) , total regurgitation ( p < 0.001 ) , eructation ( p= 0.04 ) , and early satiety ( p= 0.04 ) . Cisapride 20 mg b.i.d . was also superior to placebo in reducing total use of rescue antacid medication ( p < 0.001 ) ; reducing , in concordance analyses , daytime and nighttime heartburn with antacid usage ( p < 0.001 ) ; increasing the percentage of heartburn-free days and antacid-free nights ( p < 0.5 ) ; and increasing the percentage of patients self-rated as having minimal or better symptomatic improvement ( p= 0.01 ) . Cisapride 20 mg b.i.d . was well tolerated . The most common adverse event in the cisapride group was diarrhea , reported by 10 % of patients , compared with an incidence of 4 % in the placebo group . Conclusion : Cisapride 20 mg b.i.d . was shown to be effective and safe for the short-term treatment of daytime and nighttime heartburn and for other symptoms associated with mild-moderate GERD Since metoclopramide increases lower-esophageal-sphincter pressure in patients with gastroesophageal reflux , we compared the effects of metoclopramide , 10 mg four times daily , with those of placebo on symptoms in 31 patients with chronic heartburn . Eighteen patients completed a r and om-order , double-blind crossover study of two consecutive eight-week periods . The final 13 patients crossed over only if their symptoms were not substantially improved after the first eight weeks . Response of low-esophageal-sphincter pressure to metoclopramide did not correlate significantly with symptomatic improvement . After the metoclopramide treatment period , mean basal pressure was unchanged from values before study . In both treatment periods , metoclopramide-treated patients had significantly more symptomatic improvement than the control group ( P less than 0.05 ) In a 6 to 12-week double-blind trial , the effect of cisapride ( 10 mg q.i.d . ) was compared with that of placebo in 63 patients with esophagitis confirmed by endoscopy and /or biopsy . In only one patient ( 3 % ) in the cisapride group but in 43 % of the placebo patients ( p = 0.001 ) , symptoms had not improved after 6 weeks . Forty patients continued treatment until week 12 . At that time , control endoscopy showed a significantly ( p = 0.005 ) higher rate of healing ( no erosions , ulcers , or bleeding mucosa ) in the cisapride patients ( 63 % ) than in the placebo patients ( 12 % ) . At week 12 , only three of the 21 cisapride patients still had moderate reflux symptoms , whereas eight of the 19 placebo patients had moderate or severe symptoms ( p less than 0.05 ) . Cisapride patients also took significantly ( p less than 0.001 ) less antacids during the trial . These results show that cisapride , 10 mg q.i.d . , heals esophagitis lesions and greatly reduces associated symptoms . The treatment was well tolerated BACKGROUND : At least 10 - 15 % of patients with reflux symptoms have a normal endoscopy and physiological levels of acid reflux on pH monitoring . Such patients with 50 % or more of symptoms associated with acid reflux episodes have " a positive symptom index " ( SI ) , and it has been proposed that this defines the " sensitive oesophagus " . AIM : To test the response to omeprazole 20 mg twice daily for four weeks of patients with normal levels of acid reflux using a r and omised , placebo controlled , double blind , cross-over design . PATIENTS : Eighteen patients with normal levels of reflux 
    Output:
    
REVIEW ERS ' CONCLUSIONS The findings in this review suggest that antisecretory drugs are effective in the empirical treatment of complaints likely to originate from GORD and in treatment of ENRD and furthermore that PPIs are superior to H2RAs in empirical treatment of typical GORD symptoms