Gastro-oesophageal reflux disease — CCFP MCQ

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ModerateChronic disease managementGastro-oesophageal reflux diseaseCCFP

A 41-year-old man presents with epigastric burning after meals and nocturnal reflux occurring twice weekly. He denies dysphagia, weight loss, anaemia, vomiting, or gastrointestinal bleeding. He drinks coffee late in the evening and uses ibuprofen frequently. Physical examination is unremarkable. What is the most appropriate next step in management?

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Correct answer: B — Trial lifestyle modifications and proton-pump inhibitor therapy

Explanation lettering: C = shown as A · D = shown as B · E = shown as C · A = shown as D · B = shown as E

In primary care, GERD is diagnosed clinically based on typical symptoms of heartburn or regurgitation without requiring endoscopy. This patient has uncomplicated GERD (typical symptoms, no alarm features: no dysphagia, weight loss, anaemia, or gastrointestinal bleeding) occurring ≥2 times weekly. Canadian guidance recommends empiric trial of lifestyle modifications (reduce late-evening coffee, limit NSAIDs) combined with once-daily proton-pump inhibitor (PPI) therapy, with response assessed at 4–8 weeks. Endoscopy (A) is reserved for alarm symptoms or failed PPI response and is not appropriate here. Tumour markers (B) have no role in uncomplicated GERD. Triple H. pylori eradication (C) requires prior diagnostic testing (serology, breath, or stool antigen); empiric treatment is inappropriate. Antireflux surgery (E) is a specialist option for carefully selected patients with longstanding symptoms after documented medical failure, not a first-line approach. Answer: D.

Reference: College of Family Physicians of Canada. Appropriate prescribing and deprescribing of proton pump inhibitors. Canadian Family Physician 2026;72(3):179. https://www.cfp.ca/content/72/3/179 ; Canadian Consensus Conference on the management of gastroesophageal reflux disease in adults - update 2004. https://pubmed.ncbi.nlm.nih.gov/15685294/