Treatment Plan and Prognosis

TREATMENT PLAN

• Initial: Lifestyle approach, remove exacerbating factors
• Proven GERD: full dose PPI for 4 weeks
• Severe oesophagitis: full dose PPI for 8 weeks
• If OGD is negative for reflux, stop PPI and consider the H2 receptor antagonist
• Refractory/Recurrent cases:

• Review at 4-8 weeks
• Check compliance, consider alternatives
• Reinforce lifestyle measures
• Consider 1 month additional full/double dose PPI +/- H2RA at bedtime

• Long-term PPI: annual reviews, tapering management plan
• Refer again for OGD if:

• Severe risk factors (male, long-term GERD symptoms, previous
  oesophagitis/hiatus hernia/strictures/ulcers = these patients are at risk of
  Barret’s Oesophagus)
• Refractory to treatment
• Patient declines long-term PPI

PROGNOSIS

• If untreated: increased risk of recurrence, complications