Gastro-oesophageal reflux

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    Clinical features

    Burning stomachache or heartburn, generally relieved by antacids; acid regurgitation (often postural: while sitting forward or lying down). In the absence of dysphagia (oesophageal stenosis), these signs are benign.

    Treatment

    • First instance: encourage the patient to avoid alcohol and tobacco use.
      Give aluminium hydroxide/magnesium hydroxide PO (400 mg/400 mg tablet) a Citation a. Aluminium hydroxide/magnesium hydroxide may decrease intestinal absorption of drugs taken at the same time:
      •  atazanavir, chloroquine, digoxin, doxycycline, iron  salts, gabapentin, itraconazole, levothyroxine (take at least 2 hours apart).
      •  ciprofloxacin (take ciprofloxacin 2 hours before or 4 hours after antacids), dolutegravir (take dolutegravir 2 hours before or 6 hours after antacids), velpatasvir (take 4 hours apart). 
      : 1 to 2 tablets 3 times daily 20 minutes to one hour after meals, or 1 tablet during painful attacks.
    • If antacids are insufficient:
      omeprazole PO: 20 mg once daily in the morning for 3 days
    • In young children: no drug treatment, rest and sleep on an incline (30° to 45°).

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    Footnotes
    • (a)Aluminium hydroxide/magnesium hydroxide may decrease intestinal absorption of drugs taken at the same time:
      •  atazanavir, chloroquine, digoxin, doxycycline, iron  salts, gabapentin, itraconazole, levothyroxine (take at least 2 hours apart).
      •  ciprofloxacin (take ciprofloxacin 2 hours before or 4 hours after antacids), dolutegravir (take dolutegravir 2 hours before or 6 hours after antacids), velpatasvir (take 4 hours apart).