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Management of Gastro-oesophageal Reflux Disease (GORD)

General management

Lifestyle changes will include:

  • Weight reduction.
  • Reduced alcohol consumption.
  • Smoking cessation.
  • Avoiding precipitating foods (e.g. caffeine, chocolate and onions).
  • Raising the head of the bed at night if nocturnal symptoms. 

Review concurrent drug therapy and try to avoid the following:

  • NSAIDs (non-steroidal anti-inflammatory drugs) 
  • Anticholinergic drugs
  • SSRIs (selective serotonin re-uptake inhibitors)
  • Calcium-channel blockers.

Consider need for urgent gastrointestinal endoscopy if:

  • Alarm symptoms (e.g. unexplained weight loss, haematemesis, nausea, dysphagia)*
  • New persistent reflux in patients over the age of 55.

*Do not prescribe a proton pump inhibitor (PPI) in patients with alarm symptoms before endoscopy, as PPIs may mask symptoms of upper GI malignancy.

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 bedtime.

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 the lowest dose of PPI needed to control symptoms (N.B. this could be 'on demand' PPI treatment for mild or intermittent symptoms).

Ongoing symptoms

Try higher dose PPI and seek specialist advice.

 

Guideline reviewed: May 2023

Page last updated: March 2024