1. Gastro-oesophageal Reflux Disease (GORD) and Gastritis -

1. Gastro-oesophageal Reflux Disease (GORD) and Gastritis

Definition

GORD: is a chronic condition where gastric acid refluxes into the oesophagus causing troublesome symptoms (e.g. heartburn) or complications (e.g. oesophagitis).

Gastritis: refers to inflammation of the gastric mucosa (acute or chronic) due to infection, irritants, autoimmune causes, or systemic disease.

🛡️ Aetiology / Risk Factors

Shared	GORD-specific	Gastritis-specific
Smoking	Hiatus hernia	Helicobacter pylori infection
Alcohol / caffeine / acidic foods	Pregnancy	Autoimmune gastritis (anti-parietal cell / IF Ab)
Drugs (NSAIDs, aspirin, steroids, CCBs)
Elevated BMI (obesity)		Irritants: spicy food
		Nicotine
		Associated with GORD

🤒Clinical Features

GORD – HEARTBURN

Heartburn – retrosternal burning, worse after meals/lying flat
Epigastric pain
Acid taste / regurgitation
Relieved by antacids
Troublesome cough (night)
Bloating
Unexplained dental erosions
Repeated sore throat
Nausea/vomiting

Gastritis – PAINED

Post-prandial epigastric pain
Anaemia (chronic blood loss)
Indigestion / dyspepsia
Nausea/vomiting
Early satiety / bloating
Dark stools (melaena) in haemorrhagic cases

OGD Referral Criteria

Urgent — 2-Week Wait (ALARM55)

Urgent referral for OGD (oesophagogastroduodenoscopy) (2WW) if:

Anaemia (iron deficiency)
Loss of weight (unintentional)
Anorexia
Recent onset dysphagia
Melaena / haematemesis
55 years or older with new symptoms

2️⃣ Non-Urgent OGD — Barrett’s Risk Assessment

Consider non-urgent endoscopy for patients with GORD symptoms + multiple Barrett’s risk factors, even without red flags:

Chronic GORD symptoms (>5 years)
Age ≥50
Male sex
White ethnicity
Central obesity (waist circumference / BMI ↑)
Smoking history
First-degree relative with Barrett’s oesophagus or oesophageal adenocarcinoma

Purpose: Detect and confirm Barrett’s early for surveillance.

Investigations

Test	Indication	Notes
Clinical diagnosis	Typical symptoms, no red flags	Empirical treatment appropriate
OGD	≥55y + new symptoms • Alarm features • Poor treatment response	Biopsy if Barrett’s suspected
pH monitoring / manometry	Diagnosis uncertain after OGD	Useful for surgical planning
H. pylori testing	See treatment ladder	Stop PPI ≥2 weeks prior

Initial Assessment

Exclude red flags (↑ → urgent OGD)
Assess NSAID, alcohol, smoking use
Consider overlap with PUD or functional dyspepsia

First-line in No Red Flags

Lifestyle changes (see management)
Empirical PPI trial – omeprazole 20 mg OD for 4 weeks

H. pylori Testing — When to Test?

Test for H. pylori if:

Un-investigated dyspepsia (especially <55 years and no red flags)
Symptoms persist after PPI trial
Previous history of gastric/duodenal ulcer or gastritis
Planned long-term NSAID use, especially in patients >45 years
Known iron-deficiency anaemia, or ITP/B12 deficiency

Do not routinely test:

Asymptomatic, no ulcer history or risk factors
During/within 2 weeks of PPI use
If alarm symptoms present → refer OGD

PARA Tip:

PPIs must be stopped ≥2 weeks before urea breath test or stool antigen — common exam trap.

H. pylori Testing — Which Test to Use?

Test	When to Use	Notes
Urea Breath Test	1st-line	Stop PPI ≥2 wks before
Stool Antigen Test	1st-line	Preferred in primary care
Serology	Avoid	Cannot distinguish past vs active infection
OGD + biopsy	Red flags / failure	Also rules out malignancy & ulcers

Follow-Up

Confirm eradication 4 weeks after completing triple therapy (if given) using urea breath test or stool antigen — not serology.

Summary for PARA:

Test H. pylori in persistent dyspepsia without alarm features. Use stool antigen or breath test (PPIs stopped 2 weeks prior). Do not test if alarm symptoms present — refer for endoscopy.

Management —

Lifestyle & PRN Relief

Weight loss, smoking/alcohol cessation, avoid trigger foods/drinks, smaller frequent meals, avoid lying after eating, raise head of bed.
PRN antacids/alginates (e.g. Gaviscon Advance).

Standard PPI Trial

Omeprazole 20 mg OD × 4–8 weeks.
PHE advice: In uncomplicated dyspepsia, test for H. pylori after PPI trial (low UK prevalence <15%).
If improved → step down to lowest effective dose/on-demand.

Breakthrough Symptoms

Check adherence & lifestyle.
Offer PRN antacids between PPI doses.
If persistent → double PPI dose or trial alternative PPI.

Step-Up or Alternative

Double PPI dose (e.g. omeprazole 20 mg BD).
Switch to alternative PPI.
Add H2RA (e.g. famotidine) if PPI not tolerated.

H. pylori Eradication (if positive)

Triple therapy: PPI + amoxicillin + clarithromycin/metronidazole × 7 days.
Confirm eradication after 4 weeks (off PPI ≥2 weeks).

Refractory / Severe

OGD to rule out malignancy, Barrett’s, ulcers.
Consider surgical fundoplication for GORD if severe & PPI-resistant.
Manage autoimmune gastritis (lifelong B12 if pernicious anaemia).

Complications

GORD – Mnemonic: BEACH

Barrett’s oesophagus
Esophagitis
Anaemia
Carcinoma (adenocarcinoma risk)
Haematemesis

Gastritis – Mnemonic: BAGS

Bleeding
Anaemia
Gastric atrophy
Stomach cancer

🔎 Barrett’s Oesophagus (Key Complication)

Metaplasia: squamous → columnar epithelium
Risk of oesophageal adenocarcinoma
OGD surveillance with biopsies
Dysplasia: consider RFA or endoscopic resection

🔎 Last updated in line with:

NICE NG1 (Gastro-oesophageal reflux disease in children and young people: diagnosis and management) – Published Jan 2015 • Last updated Oct 2019
NICE CKS (Dyspepsia – acute and chronic) – Published May 2010 • Last updated Apr 2023
- PARA-aligned, reviewed February 2026
PASSMAP ensures all content is NICE-aligned and reviewed for Physician Associate Registration Assessment (PARA) success

Educational platform. Not medical advice.