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GERD — MRCGP AKT MCQ

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EasyGastroenterologyGERDMRCGP AKT

A 49-year-old presents with a 6-week history of heartburn and acid regurgitation. There is no dysphagia, gastrointestinal bleeding, persistent vomiting, anaemia, unintentional weight loss or abdominal mass. Their BMI is 31 kg/m² and they do not take NSAIDs. A carbon-13 urea breath test, performed before starting acid-suppressing treatment, is negative. What is the most appropriate initial management?

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Correct answer: C — Offer a 4-week course of a full-dose proton pump inhibitor with lifestyle measures

The correct answer is C. NICE advises that uninvestigated reflux-like symptoms should initially be managed as uninvestigated dyspepsia, with a 4-week course of a full-dose proton pump inhibitor. Lifestyle advice should accompany treatment, particularly weight reduction because the patient is obese, avoidance of individual dietary precipitants and avoiding meals shortly before bed. The valid negative H. pylori test makes repeat testing or eradication treatment inappropriate. Immediate endoscopy is not indicated at age 49 in the absence of dysphagia, bleeding, anaemia, weight loss, persistent vomiting or treatment-resistant symptoms. Sucralfate and prokinetic drugs are not recommended as routine initial treatment for uncomplicated reflux symptoms.

Reference: National Institute for Health and Care Excellence. CG184: Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management, recommendations 1.2.1–1.2.2, 1.4.3 and 1.6.1. Updated 2019. https://www.nice.org.uk/guidance/cg184/chapter/1-recommendations