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GERD — ESEGH MCQ

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EasyGastroenterologyGERDESEGH

A 61‑year‑old patient presents with typical reflux symptoms (heartburn and regurgitation) occurring on 4 days per week. There are no alarm features (no weight loss, dysphagia or gastrointestinal bleeding). What is the most appropriate initial management?

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Correct answer: B — Eight‑week trial of once‑daily proton pump inhibitor before breakfast

In a patient with typical GORD symptoms without alarm features, NICE guideline CG184 recommends first‑line management with a full‑dose proton pump inhibitor for 4 to 8 weeks. Endoscopy is not indicated initially in the absence of alarm features. H₂‑receptor antagonists are less effective and are considered only if PPIs are inappropriate or not tolerated. Antireflux surgery is reserved for PPI‑responsive patients wishing to avoid long‑term therapy, or refractory cases after specialist assessment. Bismuth quadruple therapy is for H. pylori eradication, not GERD management.

Reference: NICE CG184 “Gastro‑oesophageal reflux disease and dyspepsia in adults: investigation and management” (2014, updated 2019), https://www.nice.org.uk/guidance/cg184/chapter/Recommendations