Prospective studies are needed to investigate clinically relevant risk factors for the development of GERD and its complications; GERD progression, on and off therapy; optimal management strategies for typical GERD symptoms in primary care patients; and optimal management strategies for atypical GERD symptoms, Barrett's epithelium and esophageal adenocarcinoma.

The coordination of swallowing and respiration, as measured by nasal airflow, and the effect of changes in the volume of the swallow bolus (0-20 ml) were investigated in 12 normal subjects. Both nonbolus and bolus swallows were usually preceded and followed by expiratory airflow. Swallows followed by inspiratory airflow accounted for 20% of nonbolus swallows but decreased further in frequency in the presence of a bolus. Swallowing was associated with an apneic period lasting 1.90 +/- 0.26 s for nonbolus swallows. Based on the apneic period response to bolus volume, the subjects were divided into two groups. The apneic period decreased by 60% in seven of the subjects regardless of bolus volume. The remaining five subjects gradually increased swallow apnea as bolus volume was increased. At larger bolus volumes, the latter group also exhibited an earlier onset of the swallow apnea and an increase in the number of swallows preceded by inspiration. The duration of the swallow-associated respiratory cycle was similarly prolonged by an increase in bolus volume in both groups. The results indicate that the respiratory pattern associated with swallowing is modulated by the volume of the swallow bolus. Within the normal population, at least two different patterns of response to bolus volume are identified.

In the average Canadian ambulatory adult population, sedated diagnostic EGDE is more costly but remains an efficacious strategy by increasing the rate of successful endoscopies, patient satisfaction, and willingness to repeat. However, among the elderly (>75 yr), an unsedated strategy may be more cost-efficacious.