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  1. Richard Lehman, MRCGP, MA
  1. Department of Primary Care, University of Oxford
 Oxford, UK

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 The visible Universe began about 300 000 years after the Big Bang, when the primordial plasma had cooled enough for protons to capture electrons and form atoms of hydrogen, helium, and (in tiny amounts) lithium. Gastro-oesophageal reflux disease (GORD, or GERD in the US) begins inside us when protons produced by gastric parietal cells are able to capture electrons belonging to chlorine and form hydrochloric acid, which then splashes or trickles up through the weak valve that is supposed to confine it. For the last 20 years, we have had excellent drugs to switch off the flow of stomach protons, but wouldn’t it make more sense to tighten the valve? Surgeons have been working on this for the best part of a century, and now they may have come up with the answer: endoscopic full-thickness gastroplication. The gold standard comparator for surgical RCTs is sham surgery. Trials using it tend to turn up infrequently, but now, like London buses, 2 have turned up at the same time:

    and . They …

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