Summary of interventions for gastro-oesophageal reflux disease

Summary of Interventions for gastro-oesophageal reflux disease (GORD)

• manage uninvestigated 'reflux-like' symptoms as uninvestigated dyspepsia
• if GORD then treat with a full-dose PPI (table 1) for 4 or 8 weeks
• if symptoms recur after initial treatment, offer a PPI at the lowest dose possible to control symptoms
• discuss with people how they can manage their own symptoms by using the treatment when they need it
• offer H2RA therapy if there is an inadequate response to a PPI
• people who have had dilatation of an oesophageal stricture should remain on long-term full-dose PPI ( table 1) therapy
• a full-dose PPI (table 2) for 8 weeks should be used to heal severe oesophagitis, taking into account the person's preference and clinical circumstances (for example, underlying health conditions and possible interactions with other drugs)
• if initial treatment for healing severe oesophagitis fails, consider a high dose of the initial PPI, switching to another full-dose PPI ( table 2) or switching to another high-dose PPI ( table 2), taking into account the person's preference and clinical circumstances (for example, tolerability of the initial PPI, underlying health conditions and possible interactions with other drugs)
• offer a full-dose PPI ( table 2) long-term as maintenance treatment for people with severe oesophagitis, taking into account the person's preference and clinical circumstances (for example, tolerability of the PPI, underlying health conditions and possible interactions with other drugs)
• if the person's severe oesophagitis fails to respond to maintenance treatment, carry out a clinical review. Consider switching to another PPI at full dose or high dose ( table 2), taking into account the person's preference and clinical circumstances, and/or seeking specialist advice
• do not routinely offer endoscopy to diagnose Barrett's oesophagus, but consider it if the person has GORD. Discuss the person's preferences and their individual risk factors (for example, long duration of symptoms, increased frequency of symptoms, previous oesophagitis, previous hiatus hernia, oesophageal stricture or oesophageal ulcers, or male gender)

Table 1: PPI doses

* lower than the licensed starting dose for esomeprazole in GORD, which is 40 mg, but considered to be dose-equivalent to other PPIs. When undertaking meta-analysis of doserelated effects, NICE classed esomeprazole 20 mg as a full-dose equivalent to omeprazole 20 mg.

**off-label dose for GORD

***40 mg is recommended as a double dose of esomeprazole because the 20-mg dose is considered equivalent to omeprazole 20 mg.

Table 2: PPI doses for severe oesophagitis

* specifically for severe oesophagitis

** off-label dose for GORD.

Reference:

• (1) NICE (September 2014).Dyspepsia and gastro-oesophageal reflux disease - Investigation and management of dyspepsia, symptoms suggestive of gastro-oesophageal reflux disease, or both