What does NICE say about treatment of reflux if you don’t have any serious symptoms that need urgent referral? This blog is particularly relevant to those aged between 18-55 who are considered low risk of cancer or other serious conditions. The following information is taken directly from NICE and is designed for patients and doctors. What is reflux? Reflux is when some of the acidic stomach contents come back up the Oesophagus (or gullet, the tube from the mouth to the stomach down which food passes) towards the mouth. When this happens, the person can feel heartburn – a burning sensation in the chest because of the acid that's in the stomach. The pain is felt in the chest behind the breastbone, and it may move up towards the throat. Other symptoms include an unpleasant taste in the mouth and swallowing problems. It is generally a diagnosis made on the description of the symptoms by the patient and may not need any special tests ( The main tests a GP could consider could include, blood test for anaemia, test for H pylori, a bacteria associated with stomach acid problems and a gastroscopy) Treatment for reflux Drug treatment Your GP should offer you a course of treatment with a medicine called a proton pump inhibitor (PPI for short). The course should last for 4 or 8 weeks, depending on the severity of the reflux and how quickly your symptoms respond. If your symptoms come back If your symptoms come back after you've stopped taking the PPI, your GP should offer the PPI at the lowest dose possible to control your symptoms. They should discuss taking it only when you need it to help your symptoms. If the PPI doesn't work If the PPI hasn't helped, your GP may offer another medicine called an H2 blocker. If your symptoms come back If your symptoms come back after you've stopped taking the PPI, your GP should offer you a higher dose or treatment with a different PPI. You may need to take the treatment for a long time to control your symptoms. If the PPI doesn't work If the PPI hasn't helped, your GP should carry out a review of your symptoms, lifestyle and treatments. They may offer a different PPI or they may wish to get some specialist advice (for example, from a gastroenterologist - a doctor who specialises in the body's digestive system). Surgery Your doctor may talk with you about surgery for reflux. Surgery may be appropriate for people who do not want to take medication long-term, or for those who have unpleasant side effects from their medication. Remember – you shouldn't keep taking antacids regularly for long periods. Although they help symptoms in the short term, they won't cure the problem. What is the advice to GPs about referral? Adults with unexplained indigestion or heartburn that does not go away should talk to their GP about the possibility of being referred to see a specialist. What is “Persistent unexplained dyspepsia or reflux symptoms” Symptoms that have not led to a diagnosis being made by the healthcare professional in primary care after initial assessment (including history, examination and any appropriate primary care investigations such as endoscopy or Helicobacter pylori test). Symptoms have continued beyond a period that would normally be associated with self limiting problems. What should be included to decide about referral ? The discussion should focus on the person's preferences and their individual risk factors (long duration of symptoms, increased frequency of symptoms, previous oesophagitis, previous hiatus hernia, oesophageal stricture or oesophageal ulcers, or male gender). If people have had a previous endoscopy and there is no change in symptoms, discuss continuing management according to previous endoscopic findings. So what does this really mean? As you can see the advice is much vaguer that it was for symptoms that require an urgent cancer referral. This is partly as it is so common and in the younger group the risk of something serious is much lower The ease of access for a GP to a gastroscopy (look down into your stomach) varies considerably on where you live. Some GPs can easily get one done, others have to go through a hospital. referral. As you can see, the main issues are persistent symptoms, symptoms that change and symptoms that are not fully explained. It is also possible to discuss surgery as an option. There are no specific recommendations in respect of referral to identify Barrett’s oesophagus If you are concerned about your symptoms and feel you are not being listened to, then this advice is from NICE and may be useful to help your discussion with your GP.