GORD
Non-Pharmacological Management
Aim for weight loss 5–10% / BMI <25
Advise and support patients to stop smoking
Avoid triggers (e.g., alcohol, spicy food, caffeine)
Eat smaller meals
Avoid lying down after eating
Drink fluids between meals rather than with meals
Elevate head of bed (if symptoms occur at night)
Avoid eating or drinking within 3 hours before bedtime
Avoid tight-fitting clothes that increase intra-abdominal pressure
Mild (1x per week or less)
Lifestyle modifications may be sufficient
1st line: Antacids
Gaviscon 10–20 mL PRN
Mylanta 10–20 mL PRN
2nd line: If antacids ineffective:
Ranitidine 150 mg OD–BD PRN
Esomeprazole 20 mg OD
Review if utilising more than once per week
Frequent (≥2x per week) or Severe Symptoms
Lifestyle modifications + PPI:
Esomeprazole 20 mg daily (1 hour before a meal)
Duration: 4–8 weeks, then step down to PRN dosing, intermittent dosing, or trial cessation with H2 antagonists/antacids
If no improvement after 8 weeks → refer for endoscopy
Consider H. pylori testing if symptoms persist despite adequate PPI therapy
Long-Term PPI Side Effects
Increased fracture risk/osteoporosis (less calcium absorption)
Interstitial nephritis
C. difficile infection
Interaction with other medications, especially clopidogrel
Monitor magnesium levels in long-term PPI use due to hypomagnesaemia risk
Indications for Upper GI Endoscopy
Alarm Symptoms:
Anaemia
Dysphagia or odynophagia
Haematemesis or melaena
Vomiting
Weight loss
New symptoms in older adults
Changing symptoms
Severe or frequent symptoms
Inadequate response to treatment
Note: Endoscopy is not routinely required for typical GORD symptoms without alarm features
Management of Extra-Oesophageal Symptoms
Extra-oesophageal symptoms may include:
Chronic cough
Pharyngeal/laryngeal symptoms
Non-cardiac chest pain
Sleep disturbance
Treatment:
High-dose PPI trial for 8–12 weeks:
Esomeprazole 20 mg BD 1 hour before meals
OR Omeprazole, Pantoprazole, Rabeprazole, or Lansoprazole BD
If no response → stop PPI and consider alternative diagnoses (e.g., laryngopharyngeal reflux, functional syndromes)
GORD in Pregnancy
Management:
First-line: Lifestyle and dietary modification (e.g., smaller meals, avoiding lying down after eating)
Drug Therapy:
Safe options: Antacids and H2-receptor antagonists (e.g., ranitidine, famotidine)
PPIs: If severe and unresponsive to other treatments
Omeprazole has the most clinical safety data and experience
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