GORD — MRCGP AKT MCQ

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EasyGastroenterologyGORDMRCGP AKT UKMLA PARA

A 28-year-old woman has had recurrent heartburn and acid regurgitation for 6 weeks. She has no dysphagia, gastrointestinal bleeding, unintentional weight loss, persistent vomiting or anaemia. Examination is normal. What is the most appropriate initial pharmacological management?

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Correct answer: D — Start a full-dose proton pump inhibitor for 4 weeks

The correct answer is D. These are typical uninvestigated reflux symptoms without alarm features. NICE advises managing uninvestigated reflux-like symptoms as uninvestigated dyspepsia and offering an empirical full-dose proton pump inhibitor for 4 weeks, alongside appropriate lifestyle advice. Immediate endoscopy is not indicated in this young patient without alarm features or treatment failure. An H2-receptor antagonist is generally considered if the response to a PPI is inadequate rather than as first-line treatment. Prokinetic drugs are not recommended as routine initial therapy. If symptoms recur, treatment should be stepped down to the lowest effective PPI dose or used when required; indefinite full-dose treatment without review is inappropriate.

Reference: National Institute for Health and Care Excellence. CG184, Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management, recommendations 1.4.3, 1.5.1, 1.6.1 and 1.6.5. Updated 2019. https://www.nice.org.uk/guidance/cg184/chapter/Recommendations