GGC Medicines


Adult Therapeutics Handbook

Management of Gastro-oesophageal Reflux Disease (GORD)

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

or

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

or

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.