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GORD — MRCGP AKT MCQ

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EasyGastroenterologyGORDMRCGP AKTUKMLAPARA

A 37-year-old man has a 3-month history of retrosternal burning and acid regurgitation occurring twice weekly. Lifestyle measures have not improved his symptoms. He has no dysphagia, gastrointestinal bleeding, persistent vomiting, unintentional weight loss or anaemia. Examination is normal. What is the most appropriate initial pharmacological treatment for this uncomplicated GORD?

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Correct answer: B — Start a full-dose proton pump inhibitor once daily for 4–8 weeks

The correct answer is B. His typical heartburn and acid regurgitation, absence of alarm features and failure of lifestyle measures indicate uncomplicated GORD. NICE recommends a full-dose proton pump inhibitor for 4 or 8 weeks as initial treatment. An H2-receptor antagonist is generally offered when the response to a PPI is inadequate rather than as preferred first-line therapy. Prokinetic monotherapy is not standard initial management. Helicobacter pylori eradication should not be prescribed empirically without evidence of infection. Immediate surgical referral is inappropriate; antireflux surgery is considered selectively after further assessment, particularly when adequately managed reflux remains troublesome or long-term medication is unsuitable.

Reference: NICE, Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management (CG184), recommendations 1.6.2–1.6.5, 2014 (last updated 2019). https://www.nice.org.uk/guidance/cg184/chapter/1-recommendations