Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management

Recommendation ID: CG184/4
Question: What specialist management is effective for people whose symptoms do not respond to PPIs despite optimum primary care, or for people whose symptoms return after surgery?
Any explanatory notes (if applicable): There is a small group of people whose symptoms do not resolve, despite medical management and/or surgery for reflux. The group should be divided into people with proven (by pH monitoring) GORD and people with symptoms but no diagnosed reflux. The first group should have a trial of a twice-daily, high-dose PPI versus a standard or full-dose PPI. The second group should have a trial of tricyclic antidepressants versus standard or full-dose PPI. The purpose of any treatment should focus on improving quality of life.

Source guidance details

Comes from guidance: Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management
Number: CG184
Date issued: September 2014

Is this a recommendation for the use of a technology only in the context of research?	No
Is it a recommendation that suggests collection of data or the establishment of a register?	No
Last Reviewed	31/10/2019