31 August 2026Chapter 3: Gastrointestinal disordersPDF page 121
Gastro-oesophageal reflux
Full paraphrased clinical guide to reflux symptoms, benign patterns, red flags, lifestyle care, antacids, and short acid suppression.
This guide supports clinical education and care navigation. It does not replace bedside judgement, emergency care, specialist advice, or local treatment protocol.
Seek urgent care
- Difficulty swallowing, painful swallowing, vomiting blood, black stool, weight loss, persistent vomiting, or severe chest pain.
- Reflux symptoms with breathlessness, sweating, left arm or jaw pain, fainting, or heart disease risk.
- Symptoms in a young child with poor feeding, dehydration, respiratory distress, or failure to thrive.
Overview
Gastro-oesophageal reflux causes stomach contents or acid to move back into the oesophagus.
Heartburn and acid regurgitation are usually benign when there is no dysphagia or other alarm feature.
Clinical features
- Burning epigastric pain or heartburn.
- Acid regurgitation, often worse when lying down or bending forward.
- Symptoms may improve with antacids.
- Dysphagia suggests possible oesophageal narrowing or another serious condition and needs assessment.
Treatment
- Encourage avoidance of alcohol and tobacco use.
- Assess for alarm features before treating as benign reflux, especially dysphagia, bleeding, weight loss, recurrent vomiting, severe chest pain, or cardiac-type symptoms.
- Review persistent, recurrent, or alarm-feature reflux for peptic ulcer disease, malignancy, cardiac disease, medicine injury, pregnancy-related causes, or other diagnoses.
| Situation | Dose direction |
|---|---|
| First instance: antacid | Aluminium hydroxide/magnesium hydroxide 400 mg/400 mg: 1 to 2 tablets three times daily, 20 minutes to 1 hour after meals, or 1 tablet during painful attacks. |
| If antacids are insufficient | Omeprazole PO 20 mg once daily in the morning for 3 days. |
| Young children | No drug treatment in the source guidance; rest and sleep on a 30 to 45 degree incline when appropriate. |
Medicine interaction note
- Aluminium/magnesium antacids can reduce absorption of several medicines.
- Separate antacids by at least 2 hours from atazanavir, chloroquine, digoxin, doxycycline, iron salts, gabapentin, itraconazole, and levothyroxine.
- Give ciprofloxacin 2 hours before or 4 hours after antacids; give dolutegravir 2 hours before or 6 hours after antacids; separate velpatasvir by 4 hours.
- Handover should include alarm features, cardiac-screening concerns, medicines used, interaction risks, response to antacid/PPI, paediatric feeding/growth concerns, and follow-up plan.
Medicines in this guide
Source
MSF Clinical guidelines - Diagnosis and treatment manual (December 2024)
This page is a paraphrased clinician-oriented guide derived from the source topic on PDF page 121. Medicine-specific details should be checked against local protocol and the linked drug-information pages.