Please note: this guideline has exceeded its review date and is currently under review by specialists. Exercise caution in the use of the clinical guideline.

Management of Gastro-oesophageal Reflux Disease (GORD)

General management

Lifestyle changes will include:

Weight reduction
Reduce alcohol
Stop smoking
Avoid stooping
Raise head of bed
Avoid foods that lower LOS (lower oesophageal sphincter) pressure (e.g. caffeine, chocolate and onions).

Review concurrent drug therapy:

Avoid NSAID (non-steroidal anti-inflammatory drugs) and consider alternatives if possible for drugs likely to lower LOS pressure (e.g. any drugs with anticholinergic side effects, selective serotonin re-uptake inhibitor antidepressants, calcium-channel blockers).

Treatment options

Mild symptoms

Co-magaldrox (Mucogel^®) oral 10–20ml after meals and at bedtime, or when required

Peptac^® oral 10–20ml after meals and at night.

N.B. Avoid in cardiac failure, renal disease and hepatic disease.

Persisting symptoms

Omeprazole oral treatment dose 40mg once daily for 4–8 weeks, then maintenance dose 20mg once daily

Lansoprazole oral treatment dose 30mg once daily for 4–8 weeks, then maintenance dose 15mg once daily.

Long-term maintenance

Aim for lowest dose proton pump inhibitor (PPI) needed to control symptoms.
Encourage 'on demand' PPI treatment especially for endoscopy-negative reflux disease.

Ongoing symptoms

Try higher dose PPI and seek specialist advice.

Content last reviewed May 2019