Synopsis
Diagnose and treat gastro-oesophageal reflux pragmatically, recognise alarm features and confirm pathological reflux before invasive or prolonged escalation of therapy.
- GORD occurs when reflux of gastric contents causes troublesome symptoms or complications; heartburn alone is neither necessary nor sufficient for a conclusive diagnosis.
- Typical symptoms are burning retrosternal discomfort and acid regurgitation, often meal-related or worse supine, but chest pain must first be risk-assessed for cardiac disease.
- Dysphagia, weight loss, bleeding, iron-deficiency anaemia, persistent vomiting and an abnormal examination override empirical treatment and prompt urgent investigation.
Key red flags
Odynophagia, bleeding, anaemia or dysphagia can reflect severe oesophagitis, ulcer or peptic stricture and requires endoscopic assessment rather than indefinite empirical treatment.
Investigation priorities
Separate uncomplicated reflux from urgent structural or systemic disease.
Management branches
Typical heartburn or regurgitation occurs without alarm features or a dangerous chest-pain phenotype.
- Review alarm features, cardiac risk, pregnancy, medicines and symptom pattern; arrange urgent investigation instead of empirical therapy when the assessment is concerning.
- Offer individual weight and meal advice, then use a full-dose PPI for four or eight weeks according to NICE and the selected product instructions.
Key medicines
OmeprazoleFor symptomatic GORD, a common licensed adult regimen is 20 mg orally once daily; reflux oesophagitis is usually treated for four to eight weeks, with 40 mg daily used for severe disease under current product guidance.
Alginate-antacid preparationUse the licensed product-specific adult dose after meals and at bedtime when needed, separating it from interacting medicines in accordance with the current BNF or package instructions.