For patients with persistent or recurrent GORD symptoms despite a full-dose PPI, consider prescribing a further course of a full-dose PPI for 1 month, depending on clinical judgement NICE CKS.
If symptoms persist, consider increasing to a double dose of the initial PPI for 1 month, or adding in a histamine (H2)-receptor antagonist (H2RA) at bedtime, especially if there are nocturnal symptoms NICE CKS.
In cases of endoscopy-negative reflux disease with ongoing symptoms, switching to an H2RA for one month may be appropriate NICE CKS.
If symptoms are severe or ongoing after initial management, consider a high dose of the PPI or switching to an alternative full-dose or high-dose PPI for up to 8 weeks NICE CKS.
For patients with controlled severe oesophagitis, long-term full-dose PPI as maintenance therapy may be offered, and ongoing symptoms should prompt consideration of switching PPI or specialist referral NICE CKS.
Regular review and assessment for alarm symptoms or complications are recommended, and if symptoms are refractory, referral to a gastroenterologist for further investigation and management should be considered NICE CKS.