***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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    ***EXAMPLES*** 
    Input: On-dem and therapy is effective for maintaining symptoms control in nonerosive gastroesophagealreflux disease ( GERD ) . Our aim was to assess the clinical effectiveness of on-dem and therapy witha proton pump inhibitor ( PPI ) in mild GERD ( nonerosive and low- grade esophagitis ) , its impact onhealth-related quality of life ( HRQoL ) , and the degree of patient satisfaction . Fifty-five patients ( 17with nonerosive GERD and 38 with low- grade esophagitis ) were treated with rabeprazole , 20 mg/day . The healed patients started on-dem and therapy . We evaluated symptoms ( clinical question naire),HRQoL ( SF-36 question naire ) , and patient satisfaction ( visual analogue scale ) . Of the 55 patients included , 51 started on-dem and therapy for 6 months . Symptom control ( heartburn < twice a week)was achieved in over 85 % of the patients . The mean ( SD ) amount of PPI used was 0.3 (0.19)tablet/day . The patient satisfaction score at the end of the acute phase was 98 ( range , 0 - 100 ) and remained high ( 90 ; range , 10 - 100 ) and stable during on-dem and therapy . Short-term treatmentnormalized the HRQoL scores , which were subsequently maintained during on-dem and therapy . On-dem and therapy is useful for the clinical management of patients with mild GERD , allowingadequate symptoms control , limiting PPI consumption , and affording important patient satisfactionwith normalization of 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 To compare the efficacy of conventional versus on-dem and ( symptomatic ) treatment of duodenal ulcer , 81 patients were r and omized into two groups . Group A ( n = 40 ) patients were treated with ranitidine 150 mg twice daily until complete ulcer healing was achieved . Group B ( n = 41 ) received a similar dose of ranitidine until complete relief of pain was achieved , irrespective of ulcer healing . Recurrence of ulcer in group A was treated with a full course of treatment until complete healing of the ulcer was achieved again , whereas , in group B , treatment was given only until pain recurrence was symptomatically controlled . Endoscopic examination was performed each month . Analysis of the results at 8 wk and 28 wk showed that 1 ) ulcer healing in group A was significantly superior to that in group B up to 24 wk , but at 28 wk the difference was no longer statistically significant ( 95 % vs 70 % ) , 2 ) the number of painful days were similar in the two groups , 3 ) group A patients took treatment for a significantly longer period than those in group B , 4 ) the cost of treatment per patient in group A was significantly greater than that in group B , 5 ) the recurrence rate assessed in patients followed for 28 wk after complete ulcer healing was similar in the two groups , and 6 ) the ulcer-related complications were not significantly different in the two groups . These findings indicate that , although on-dem and treatment results in slower ulcer healing , it is not associated with an increase in the duration of pain and incidence of complications . A major advantage of this approach was a significant reduction in the cost of treatment . It is concluded that on-dem and treatment is an attractive alternative therapeutic approach in the management of duodenal ulcer disease The present study was performed to compare pain-related oesophageal motility , gastro-oesophageal reflux and ST-segment deviations in patients with intermittent chest pain and normal or pathological coronary angiography . Thirty patients ( 11 males , 19 females ; mean age 54.8 years ) with normal and 15 patients ( 12 males , 3 females ; mean age 66.7 years ) with pathological coronary angiography were investigated by  24-h oesophageal pressure , pH and ECG recording . Chest pain correlated with motility abnormalities or gastro-oesophageal reflux occurred in 33 % ( 10/30 ) of patients with normal coronary arteries and in 26 % of patients with pathological coronary angiography . Symptomatic and asymptomatic ST-segment changes were less frequently observed in patients with normal angiography ( 4/30 ) than in patients with pathological coronary angiography ( 7/14 ; P = 0.02 ) . Oesophageal dysfunction coincided with ST-segment deviation in 6.7 % ( 2/30 ) of patients with normal and 40 % ( 6/15 ) of patients with pathological coronary angiography ( P = 0.02 ) . The conclusions reached were : ( 1 ) pain-correlated abnormal motility or gastro-oesophageal reflux occurred in patients with normal and pathological coronary angiography at the same frequency ; ( 2 ) ambulatory motility and pH recording alone does not appear to differentiate between cardiac and non-cardiac chest pain ; ( 3 ) simultaneous ECG recording reveals a significant correlation of ST-segment deviation and gastro-oesophageal reflux or abnormal motility in patients with coronary artery stenosis The efficacy of fundoplication operations in the long-term management of  gastroesophageal reflux disease ( GERD )  has been documented . However , only a few prospect i ve controlled series support the longterm ( > 10 years ) efficacy of these procedures , and further data are required to also determine whether the type of fundoplication affects the frequency of postfundoplication complaints . The aim of this study was to conduct a r and omized , controlled clinical trial to assess the long-term symptomatic outcome of a partial posterior fundoplication as compared to a total fundic wrap . During the years 1983 to 1991 , a total of 13 7 patients with chronic gastroesophageal reflux disease were enrolled in the study ; 72 were r and omized to semifundoplication ( Toupet ) and 65 to total fundoplication ( Nissen-Rossetti ) .  A st and ardized symptom question naire was used for follow-up of these patients . A total of 110 patients completed a median follow-up of 11.5 years ; 54 had a total wrap  and 56 underwent a partial posterior fundoplication . During this period , seven patients required reoperation ( Nissen-Rossetti in 5 and Toupet in 2 ) , 11 patients died , and nine patients were lost to follow-up or did not comply with the follow-up program . Control of heartburn ( no symptoms or mild , intermittent symptoms ) was achieved in 88 % and 92 % in the total and partial fundoplication groups , respectively , and the corresponding figures for control of acid regurgitation were 90 % and 94 % . We observed no difference in dysphagia scoring between the two groups , although odynophagia was somewhat more frequently reported in those undergoing a total fundoplication . On the other h and , a significant difference was observed in the prevalence of rectal flatus and postpr and ial fullness , which were recorded significantly more often in those undergoing a total fundoplication ( P < 0.001 and P < 0.03 , respectively ) . Posterior partial fundoplication seems to maintain the same high level of reflux control as total fundoplication . Earlier observations demonstrating the advantages of a partial fundoplication , which included fewer complaints associated with gas-bloat , continue to be valid after more than 10 years of follow-up Patients undergoing anaesthesia for cataract surgery were anaesthetized and their lungs ventilated by intermittent positive pressure ventilation . In one group , ventilation was facilitated by tracheal intubation and in the other group by laryngeal mask airway ( LMA ) .  Reflux of stomach contents into the oesophagus was monitored continuously using an indwelling  oesophageal pH electrode . The number of discrete episodes of reflux was higher in the LMA group ( P = 0.0178 ) , as was the incidence of reflux at antagonism of neuromuscular block ( P = 0.0349 ) Two hundred and sixty seven patients with duodenal ulceration were entered into a five year study of two strategies of treatment with cimetidine . Two thirds were treated continuously with 400 mg at bedtime supplemented by temporary increases in dosage if they had symptomatic relapses ( group 1 ) , and the remaining third were given intermittent “ healing ” doses for four to eight weeks if a symptomatic recurrence was judged to have occurred ( group 2 ) . Life table analysis showed that the probability of remaining free of clinical ly important symptoms five years after the start of treatment was 24 % ( 95 % confidence interval ( CI ) 15·5 % to 32·6 % ) in group 1 compared with nil in group 2 ( p<0·0001 ) . The median values for the longest periods free from relapse for each patient were 108 weeks in group 1 and 32 weeks in group 2 , respectively ( p<0·0001 ; 95 % CI of the median difference 36 to 76 ) . Over the five years 10 patients suffered major complications , two requiring emergency surgery , while a further nine had elective surgery because of the failure of medical treatment . There were no deaths that could be attributed either to ulceration or to treatment with cimetidine . Medical management was therefore very satisfactory for most patients , though those treated continuously with cimetidine suffered considerably less from their ulcer symptoms . As 80 % of patients studied relapsed during the two years after a healing course of cimetidine , continuous treatment will benefit many patients treated in general practice The head-downwards tipped position for physiotherapy has been cl aim ed to exacerbate gastro-oesophageal reflux ( GOR ) in infants with cystic fibrosis ( CF ) . This was investigated using lower oesophageal pH monitoring during physiotherapy .  Twenty-one infants ( age range 1 - 27 months ) with respiratory disorders ( CF=11 ) , undergoing lower oesophageal pH monitoring were recruited . Subjects received two physiotherapy episodes in r and om order , A/B or B/A , 12 h apart . A began the gravity-assisted positioning head downward tip for : right lower lobe , middle lobe , left lower lobe and lingula ; then supine with no tip for anterior segments of the upper lobes followed by apical segments of upper lobes in a sitting position . B was in the reverse order . Intermittent chest clapping was carried out for 4 min in each position by a physiotherapist blinded to the pH data . During episode A , the median change in pH from baseline was -0.32 ( range -2.07 to + 1.0 ) in non-CF subjects ( NS ) and -0.52 ( range -2.7 to + 0.52 ) in CF subjects ( p<0.02 ) . During episode B , the median change in non-CF subjects was -0.1 ( NS ; range - 1.7 to -0.15 ) and in CF subjects was -0.05 ( NS ; range -0.67 to + 0.5 ) . There was no order effect for positioning . In the CF subjects the sitting position was twice as likely to have the lowest pH measurement during physiotherapy than the other positions ( p<0.04 ) . In conclusion , the head-downward tipped positioning for physiotherapy treatment neither induces nor aggravates gastro-oesophageal reflux . There is no justification for routinely changing the way in which infant physiotherapy is carried out BACKGROUND The length of time until symptom relief and the consistency of response are important aspects of the management of episodes of gastro-oesophageal reflux disease ( GORD ) . METHODS In an open , r and omized , crossover study 98 patients treated 3 episodes of GORD with ranitidine effervescent formulation and 3 with ranitidine st and ard formulation .  The patients filled in a diary card during the 1st h after each study medication . Satisfaction with the formulations and the formulation of choice were determined at the 
    Output:
    
Intermittent proton pump inhibitor or H2-receptor antagonist therapy is not effective in maintaining control in oesophagitis patients .
H2-receptor antagonists are effective for relief of heartburn episodes .
On-dem and proton pump inhibitor therapy may work in a proportion of non-erosive gastro-oesophageal reflux disease patients