Heartburn, regurgitation, dental enamel loss, pharyngitis (no exam finding)
Treat: Lifestyle + PPI (omeprazole 20–40 mg daily before breakfast ×8 wk)
Alarm features (dysphagia, weight loss, anemia, age) → Upper endoscopy
Barrett esophagus → surveillance endoscopy
Order set
- Clinical diagnosis
- PPI trial
- Endoscopy if alarm features
Criteria
AdmitComplication (bleed, stricture)
DischargeSymptoms controlled; scope if alarm features
Clinical detail — differentials, red flags, pitfalls, disposition
Red flags
- Dysphagia
- Weight loss
- Anaemia
- GI bleed
Differentials
- Cardiac pain
- PUD
- Eosinophilic oesophagitis
- Biliary
Common mistakes
- Missing Barrett/malignancy
- Long-term PPI without review
Disposition & follow-up
Lifestyle + PPI; scope if alarm; Barrett surveillance.
Discharge package
MedicationsPPI; step-down plan
Follow-upScope if alarm features; Barrett surveillance
LifestyleWeight loss, avoid triggers, elevate head of bed
Warning symptomsDysphagia, weight loss, GI bleeding
💊 Treatment detail — doses & preparation
OmeprazolePPI
Dose20–40 mg OD 30 min before breakfast ×4–8 wk
Preparation20/40 mg capsules (MUPS dispersible for NG)
MonitorLong-term: Mg²⁺, B12, C. diff risk
Alginate/antacidsymptomatic
Dose10–20 mL after meals + bedtime (Gaviscon)
PreparationReady suspension
MonitorStep-down to lowest effective PPI dose
📖 ACG GERDReviewed July 2026