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Gastro-oesophageal reflux disease — CCFP MCQ

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EasyChronic disease managementGastro-oesophageal reflux diseaseCCFP

A 50-year-old man presents with heartburn occurring 4 days per week for 4 months. He has no dysphagia, gastrointestinal bleeding, weight loss, anaemia or vomiting. Lifestyle modifications provide only partial symptom relief. What is the most appropriate next step in management?

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Correct answer: B — Start an empiric once-daily proton pump inhibitor and reassess response after 4 to 8 weeks

This patient has uncomplicated GERD (frequent heartburn without alarm features: no dysphagia, bleeding, weight loss, or anaemia). Canadian Consensus Conference and CFPC guidance recommend empiric PPI therapy as first-line management without initial investigation. The patient should start once-daily PPI and response assessed at 4–8 weeks. If symptoms resolve, continue at the lowest effective dose; if inadequate response, escalation or specialist referral follows. No endoscopy is indicated without alarm features; H. pylori testing and antibiotics are inappropriate without confirmed infection; CT and opioids are not indicated. This approach reflects safe, efficient, evidence-based primary care management of GERD in Canada.

Reference: Canadian Consensus Conference on the management of gastroesophageal reflux disease in adults—update 2004; CFPC Approach to GERD in Primary Care (2008) and Appropriate PPI Prescribing (2026); Choosing Wisely Canada PPI Toolkit (2025). https://pubmed.ncbi.nlm.nih.gov/15685294/; https://www.cfp.ca/content/54/5/701; https://www.cfp.ca/content/72/3/179