Alarm Symptoms Need Urgent EndoscopyDifficulty swallowing (dysphagia), persistent vomiting, unintentional weight loss, vomiting blood, or new heartburn over age 55 — these require urgent upper GI endoscopy to exclude cancer.
Dietary Triggers
| Trigger | Mechanism |
|---|---|
| High-fat foods | Relax lower oesophageal sphincter (LOS) |
| Chocolate, peppermint | Relax LOS |
| Coffee and alcohol | Stimulate acid secretion + relax LOS |
| Carbonated drinks | Increase gastric pressure → reflux |
| Tomatoes and citrus | Acidic — directly irritate inflamed oesophagus |
| Late meals (within 3 hours of bed) | Gastric distension when lying → reflux |
Management Ladder
- Lifestyle: elevate bed head 15–20 cm; avoid triggers; lose weight (strongly linked); eat smaller meals; don't lie down for 3 hours after eating
- Antacids (Gaviscon, Rennies) — neutralise acid; symptom relief only
- H2 blockers (famotidine, ranitidine) — reduce acid for mild GERD
- PPIs (omeprazole, lansoprazole, esomeprazole) — most effective acid suppression; use lowest effective dose; consider step-down after 8 weeks
- Laparoscopic fundoplication — surgical option for refractory GERD or those refusing lifelong PPIs
Take PPIs CorrectlyPPIs work best taken 30–60 minutes before the first meal of the day. Taking them with food significantly reduces their effectiveness. Many people take them incorrectly and assume they're not working.
Are PPIs safe long term?
PPIs are generally safe for long-term use, but long-term use (>1 year) is associated with reduced vitamin B12 and magnesium absorption, increased fracture risk, and C. difficile diarrhoea. Use the lowest effective dose and review annually.
What is Barrett's oesophagus?
A pre-cancerous condition where the normal oesophageal lining is replaced by intestinal-type cells — caused by chronic acid reflux. It requires endoscopic surveillance every 2–5 years depending on grade of dysplasia.
How is GERD diagnosed?
Usually a clinical diagnosis based on typical symptoms responding to PPIs. 24-hour ambulatory pH monitoring is the gold standard. Upper GI endoscopy is used if alarm features are present or treatment fails.
Can GERD cause a cough?
Yes — extra-oesophageal GERD causes hoarseness, chronic cough, laryngitis, and asthma-like symptoms. A trial of high-dose PPI for 8 weeks is both diagnostic and therapeutic.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.