West of Scotland Formulary

GORD treatment options include antacids, alginates, H2 receptor antagonists, or proton pump inhibitors.

H2 receptor antagonist.

Prescribing Notes:

Chronic GORD patients should be treated with a proton pump inhibitor. The role of antacids and alginates are as an adjunct to acid suppression or for those with infrequent symptoms.
Omeprazole capsules should be prescribed rather than tablets. Tablets are a more expensive formulation with no additional benefit.
PPIs are most effective when taken on an empty stomach, 20-30 minutes before breakfast.
In most patients with gastro-oesophageal reflux disease, adequate symptom control is the principal aim of treatment. A ‘step down’ approach is encouraged starting with 20mg omeprazole daily or 30mg lansoprazole daily. The dose is then adjusted upwards or downwards to maintain symptom control using the lowest dose of the most cost-effective agent (antacid, H2-receptor antagonist or proton pump inhibitor). An ‘on demand’ regimen is an option.
Patients with endoscopically proven severe oesophagitis or with reflux-related oesophageal strictures require long-term therapy using a minimum dose of omeprazole 20mg daily or 30mg lansoprazole daily.
The patient should be reviewed and the diagnosis reconsidered in those who do not respond to 40mg omeprazole daily or 30mg lansoprazole daily within a 2-4 week period.
Antacids should be used for 10-14 days when withdrawing PPI treatment, to help with rebound symptoms.
Lansoprazole orodispersible tablets should be reserved for patients with swallowing difficulties or who require a proton pump inhibitor via nasogastric (NG) or percutaneous endoscopic gastrostomy (PEG) tube. Lansoprazole orodispersible tablets are preferred to omeprazole dispersible tablets.
PPIs should be used with caution in the elderly. There may be an association between PPI use and Clostridioides difficile (C.diff) infection and osteoporosis. Careful consideration should be made to the risk benefit ratio.

History Notes

15/04/2026

Regional formulary chapter launched.

GORD treatment options include antacids, alginates, H2 receptor antagonists, or proton pump inhibitors.

Antacids.

Alginates. Please note there is a lower dosage advised for Gaviscon Advance products compared to Peptac.

Prescribing Notes:

The role of antacids and alginates are as an adjunct to acid suppression or for those with infrequent symptoms. Chronic GORD patients should be treated with a proton pump inhibitor.
Liquid formulations of antacids are more effective than tablets or capsules.
Compound alginic acid preparations are less powerful antacids than co-magaldrox but may be more effective for heartburn.
Antacids should be used for 10-14 days when withdrawing PPI treatment, to help with rebound symptoms.

History Notes

15/04/2026

Regional formulary chapter launched.

Prescribing Notes:

PPIs should ideally not be used, prior to diagnosis by endoscopy, in patients presenting with upper gastrointestinal bleeding.
Following high dose intravenous PPI infusion, patients should be switched to oral lansoprazole or omeprazole.
In other ulcer patients an oral PPI should be initiated, to start the ulcer healing process. There is no need for IV PPI use in this patient group.
Other regular use of intravenous PPIs is not indicated, i.e. patients that are nil by mouth.

History Notes

15/04/2026

Regional formulary chapter launched.

History Notes

15/04/2026

Regional formulary chapter launched.