Click here to access the pathway for the management of new patients presenting with symptoms of GORD.

The following additional notes are also available in the pathway by clicking the information button on relevant nodes:

1. Alarm symptoms – unexplained weight loss, evidence of GI blood loss, dysphagia, persistent vomiting, upper abdominal mass, anorexia
2. Medication associated with GI symptoms includes: NSAIDs, clopidogrel, steroids, bisphosphonates, theophyllines, calcium channel blockers, nicorandil methotrexate, iron/potassium preparations
3. Lifestyle advice – give patient information leaflet on gastro-oesophageal reflux disease – leaflet is available on www.dgprescribingmatters.co.uk website or from your Prescribing Support Team.
4. Alginates – formulary choice Peptac Liquid or Gaviscon Advance liquid which should be taken after meals and at bed times. Alginates offer oesophageal protection from acid, pepsin and bile salts.
5. H2 antagonist – formulary choice ranitidine 150mg twice daily (or 300mg once daily) – treat the episodes with H2 antagonist if this resolves the symptoms
6. Proton Pump Inhibitor (PPI) – formulary choice lanzoprazole 30mg or omeprazole 20mg
7. Evidence from pilot studies shows that only one or two episodes per year are likely where patients will require a four week PPI course. Maintenance PPI therapy may be indicated for some patients such as those on certain drug regimens e.g. high dose steroids or NSAIDs, patients with strictures or endoscopically verified oesophageal erosions or those suffering from cancer, Barrets Oesophagus or having a history of oesophageal varices or severe GI bleed.