A disorder which develops as a consequence of the reflux of gastric and duodenal contents into the oesophagus. It is usually characterised by heartburn and regurgitation. Complications that may develop in severe disease are strictures, ulceration, Barrett’s oesophagus and adenocarcinoma of the oesophagus. Two thirds of patients have a normal endoscopy which is termed non-erosive reflux disease (NERD).
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.
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 trial with a PPI confirms acid-related disease. Only if no alarm symptoms:
• Omeprazole, oral, 40 mg daily for 4 weeks. Recurrence of symptoms After endoscopic confirmation of disease:
• Omeprazole, oral, 20 mg daily. o 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 Barrett’s oesophagitis reduces dysplasia or progression to malignancy.
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.
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