What is the appropriate duration for a trial of proton pump inhibitors (PPIs) in managing GERD symptoms before considering further investigation?

The appropriate duration for a trial of proton pump inhibitors (PPIs) in managing gastroesophageal reflux disease (GORD) symptoms before considering further investigations is generally 4 weeks for initial treatment.

For adults with proven GORD or endoscopy-negative reflux disease, a full-dose PPI is recommended for 4 weeks to aid healing and symptom control.

If symptoms persist or are severe (such as severe oesophagitis), an 8-week course of full-dose PPI may be appropriate before further action.

If symptoms are refractory or recurrent after this initial management period, further investigations or specialist referral should be considered.

In children and young people with persistent symptoms, a 4-week trial of PPI or H2 receptor antagonist is also recommended before considering specialist referral or endoscopy.

This approach balances effective symptom control with timely identification of those needing further diagnostic evaluation.

Summary: Trial of full-dose PPI for 4 weeks initially; extend to 8 weeks if severe oesophagitis; consider further investigations if symptoms persist or recur after this period.

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