Managing gastro-oesophageal reflux disease in primary care

The National Institute for Clinical Excellence recently issued guidance on the use of proton pump inhibitors (PPIs) in the management of dyspepsia, including gastro-oesophageal reflux disease (GORD). GORD is a common disorder that reduces quality of life and can indicate serious disease such as reflux oesophagitis. The symptoms of GORD must be distinguished from those of other diseases, such as functional dyspepsia or cardiac problems. Furthermore, atypical alarm symptoms, such as bleeding or sudden weight loss, require urgent further investigation. Most GORD is uncomplicated and can be treated using management algorithms that make the best use of resources. Newer strategies such as 'step-down' or 'on-demand' therapy can cost-effectively improve the long-term management and quality of life of patients with recurrent GORD.