Management of oesophageal reflux

• Any patient with worrying symptoms such as dysphagia or weight loss, or those found to be anaemic should be referred for endoscopy.
• Any patient with severe symptoms persisting for two weeks or more who is aged over 45 should be referred for endoscopy.
• Any patient who because of extreme age or infirmity would constitute an increased endoscopic risk should be treated empirically, including the use of proton pump inhibitors.
• Any patient whose symptoms are mild or infrequent should be offered lifestyle advice (STRAWS) and antacids or alginates.
• Patients under the age of 45 who do rot respond to the above measures, or whose symptoms are severe should be given a 2-3 month trial of an H2 receptor blocker or prokinetic drug.
• Patients who do not respond to 5, or who relapse after discontinuation should be referred for endoscopy.

Management of peptic ulcer
Ulcer maintenance therapy

Bradley Cheek 1999