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  4. Gastro-Oesophageal Reflux Disease (GORD)

Gastro-Oesophageal Reflux Disease (GORD)

NICE CKS Dyspepsia - proven GORD. Last revised: Jul 2023. NICE Clinical guideline [CG184] Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. Last updated: Oct 2019.

Guidelines

Offer urgent upper gastrointestinal endoscopy (to be performed within 2 weeks) if:
  • Dysphagia alone, or
  • ≥55 y/o with weight loss and any of the following:
    • Upper abdominal pain
    • Reflux
    • Dyspepsia

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for people with an upper abdominal mass consistent with stomach cancer.

Consider non-urgent direct access upper gastrointestinal endoscopy in people with haematemesis.

Consider non-urgent direct access upper gastrointestinal endoscopy in ≥55 y/o with:
  • Treatment-resistant dyspepsia, or
  • Upper abdominal pain with low haemoglobin levels, or
  • Raised platelet count with any of the following:
    • Nausea,
    • Vomiting,
    • Weight loss,
    • Reflux,
    • Dyspepsia,
    • Upper abdominal pain, or
  • Nausea or vomiting with any of the following:
    • Weight loss.
    • Reflux.
    • Dyspepsia.
    • Upper abdominal pain.

Offer the following to ALL patients:

  • Medication review
  • Lifestyle advice
    • Healthy eating
    • Weight reduction
    • Smoking cessation
    • Reduce alcohol consumption
 
  • Avoid known precipitants associated with their dyspepsia (e.g. smoking, alcohol, coffee, chocolate, fatty food)
  • Raising the head of the bed
    • For example, by placing wood / bricks under the bed head
    • NICE CKS recommends against using additional pillows, as they may increase intra-abdominal pressure
  • Eat smaller meals and eat their evening meal 3–4 hours before going to bed
  • Assess and manage any stress and anxiety

1st line: full-dose PPIProton pump inhibitor for 4 weeks

2nd line (if refractory to PPI):
  • Consider long-term maintenance treatment with PPIProton pump inhibitor
  • Consider H2-receptor antagonist (e.g. ranitidine, famotidine, nizatidine)

 

In the context of proven GORD, do NOT offer H. pylori test and treat.

Regarding long-term treatment with PPI, advise:

  • Long-term PPI is not routinely recommended
  • Use lowest effective dose to control symptoms
  • If possible, step down or stop treatment
  • Consider self-treatment with antacid and/or alginate therapy, although not recommended for long-term or continuous use

Consider further investigations
  • Oesophageal manometry (to exclude oesophageal motility disorder)
  • Ambulatory 24-hour oesophageal pH monitoring
  • Barium swallow / meal (to exclude structural disorders or motility disorders)


Consider laparoscopic fundoplication - gold standard for anti-reflux surgery

References

Author: Adams Lau
Reviewer:
Last edited: 05/08/25