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How to Treat Gastro Oesophageal Reflux Disease?


Things to note:
  • Dietary advice by dietician.
  • Weight reduction is recommended if overweight.
  • All patients with alarm symptoms, i.e. weight loss, haematemesis and melaena, dysphagia, and anaemia, should have an endoscopy at the earliest opportunity.

Medical Treatment:
Empiric treatment only if there are no alarm symptoms, i.e. no weight loss, no haematemesis and under 45 years of age:
  • Ranitidine, oral, 150 mg 12 hourly for 4 weeks.
OR
Proton pump inhibitors (PPIs)
A PPI trial confirms acid - related disease only if there are no symptoms of alarm.
  • Omeprazole, oral, 40 mg daily for 4 weeks.
Symptoms recurrence
Following endoscopic disease confirmation:
  • Omeprazole, oral, 20 mg daily.
  • Decrease to 10 mg daily after 4 weeks.
  • Barretts oesophagitis
    Restart PPI:
    • Omeprazole, oral, 20 mg daily.
    Note:
    • These patients usually need maintenance PPI therapy.
    • There is no convincing evidence that long-term treatment of Barretts oesophagitis reduces dysplasia or progression to malignancy.

    When to refer:
    For consideration of surgery in:
    • Young patients who are PPI dependent and will require life-long therapy;
    • Patients unable to take PPIs;
    • Patients requiring high doses of PPIs with significant expense;
    • Patients with large hiatus hernias and volume reflux;
    • A rolling hiatus hernia with obstructive symptoms requires surgery.