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Clinical revolutions come and go but doctors have to deal with the constancy of their patients and their problems. The advent of the acid suppression drugs, particularly the proton pump inhibitors (PPIs), initiated a revolution in the management of upper gastrointestinal problems. This was particularly effective for the management of gastroesophageal reflux disease (GERD), with the promise of a near abolition of symptoms. Suppressing acid was the key. The truth, as so often is the case, has however, turned out to be more complex and a little different.1 The original relatively simple entity of heartburn and reflux disease has transformed into a complex arborisation of clinical problems that embraces systemic symptoms, major quality of life issues, laryngeal and pulmonary problems and even a neoplastic threat - Barrett's

NERD: a new approach in managing reflux symptoms