Gastro-oesophageal reflux

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°).

​​​​​​​