Troublesome symptoms or complications from reflux of gastric contents into oesophagus.
History taking
- • Heartburn, regurgitation, especially postprandial and recumbent
- • Cough, hoarseness, asthma-like symptoms (extra-oesophageal)
- • Triggers: large meals, fatty/spicy food, alcohol, late dinners
Examination
- • Usually normal; check BMI, dental erosions
Red flags
- • Dysphagia, odynophagia, weight loss, GI bleed, anaemia
- • Chest pain — exclude cardiac
Differential diagnosis
- • Functional dyspepsia, eosinophilic oesophagitis
- • PUD, oesophageal motility disorder, malignancy
Recommended investigations
- • Clinical diagnosis if classic symptoms
- • Endoscopy if alarm symptoms, refractory, or >55
- • 24-h pH metry/impedance if diagnostic uncertainty
Diagnosis
- • Clinical + response to PPI; endoscopic findings (LA grading) if performed
Initial treatment / management
- • Lifestyle: weight loss, head-end elevation, last meal 3 h before bed, avoid triggers
- • PPI 8 weeks; step down to lowest effective dose
Prescription examples
- • Tab Pantoprazole 40 mg PO OD before breakfast x 8 weeks
- • Tab Domperidone 10 mg PO TDS before meals (if prokinetic needed)
- • Antacid suspension PRN
Follow-up advice
- • Review at 8 weeks; consider step-down or on-demand therapy
- • Endoscopy if symptoms persist or alarm features
Patient counselling
- • Sustained lifestyle change; weight loss key in obese
- • Risks of chronic PPI use
Referral criteria
- • Refractory GERD, suspected Barrett oesophagus, complications
Clinical pearls
- • Take PPI 30–60 min before meals for best efficacy
- • Barrett oesophagus mandates surveillance endoscopy
References
- • ACG Clinical Guideline: GERD 2022
- • NICE CG184: GORD in Adults
Educational outpatient guide — verify against local guidelines before clinical use.
