What are the first-line management options for an adult presenting with typical symptoms of GERD?

First-line management options for an adult presenting with typical symptoms of gastroesophageal reflux disease (GORD) include:

• Assess for alarm symptoms that may suggest complications or serious underlying pathology and manage appropriately.
• Offer written information and advice on symptoms, self-care, and management options for GORD.
• Advise lifestyle modifications such as losing weight if overweight or obese, avoiding trigger foods (e.g., coffee, chocolate, tomatoes, fatty or spicy foods), eating smaller meals, and having the evening meal 3–4 hours before bedtime.
• Encourage smoking cessation and reduction of alcohol consumption to recommended limits.
• Advise sleeping with the head of the bed raised by 10–20 cm rather than using additional pillows.
• Assess and manage stress and anxiety which may worsen symptoms, encouraging relaxation strategies if needed.
• Review current medications and consider reducing or stopping drugs that may exacerbate symptoms if appropriate (e.g., alpha-blockers, calcium-channel blockers, bisphosphonates, corticosteroids, nitrates, tricyclic antidepressants).
• If symptoms persist and GORD is proven, offer a full-dose proton pump inhibitor (PPI) for 4 weeks to aid healing.

Follow-up is advised if symptoms are refractory or recurrent after initial management.

Testing for Helicobacter pylori infection is not routinely recommended in GORD management.

These recommendations are based on expert opinion and NICE guidelines for GORD management in adults ¹.