Guidelines for the treatment of Gastro-oesophageal Reflux Disease (GORD)

Symptoms of reflux are extremely common, and treatment should be approached in a stepwise manner.

 1. Diet and lifestyle changes

  Patients should be advised to :

lose weight


stop smoking


avoid alcohol, coffee, spicy and fatty foods


eat smaller quantities more frequently


avoid late night eating

 2. Antacids/Alginates

Two-thirds of patients have symptom relief with an antacid/alginate combination.
A 'raft' is thought to form on the surface of the stomach contents, providing a barrier to reflux of gastric contents. These agents should be administered after meals and at bedtime. Consideration should be given to their sodium content in patients with cardiovascular disease. Low sodium alternatives are highlighted in section 1.1.

Patients over 45 years with new dyspepsia other than isolated heartburn or acid regurgitation, should be investigated.

3. Acid suppression or pro-kinetic agents

These may be used alone or in combination, for 6-8 weeks. H₂-antagonists should be used first line. Metoclopramide and domperidone promote gastric emptying and increase lower oesophageal sphincter pressure. Occasionally these drugs, particularly metoclopramide, induce extrapyramidal reactions.

4. If symptoms persist, refer for endoscopy.

Treat with a proton-pump inhibitor for 4 to 8 weeks. If relapse occurs, consider long-term treatment with an H₂-antagonist or proton-pump inhibitor.
For further advice, consult a gastroenterologist.