# Gastro-oesophageal reflux disease (GERD) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ACG Management of GERD 2022 for the indication, with the dose from Baclofen 10 mg Tablets SmPC section 4.2 (eMC product 102514), which titrates "5mg three times a day for three days", then "10mg three times a day for three days", then "15mg three times a day for three days", then "20mg three times a day for three days". The SmPC's only indication is spasticity, so use in reflux is off-label and rests on the ACG guideline, which is not held in this corpus. · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 · ACG Management of GERD 2022 · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (famotidine monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (esomeprazole monograph) · Gaviscon Double Action Aniseed Oral Suspension SmPC section 4.2 (eMC product 685) · Sucralfate 1 g tablets US prescribing information, Dosage and Administration (DailyMed, Amneal Pharmaceuticals NY LLC) - Verified date: 2026-08 ## Verified against - ACG Management of GERD 2022 for the indication, with the dose from Baclofen 10 mg Tablets SmPC section 4.2 (eMC product 102514), which titrates "5mg three times a day for three days", then "10mg three times a day for three days", then "15mg three times a day for three days", then "20mg three times a day for three days". The SmPC's only indication is spasticity, so use in reflux is off-label and rests on the ACG guideline, which is not held in this corpus. - ACG Management of GERD 2022 - Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (famotidine monograph) - Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (esomeprazole monograph) - Gaviscon Double Action Aniseed Oral Suspension SmPC section 4.2 (eMC product 685) - Sucralfate 1 g tablets US prescribing information, Dosage and Administration (DailyMed, Amneal Pharmaceuticals NY LLC) - Gastro-oesophageal reflux disease (GERD) - disease-level clinical article (gerd-clinical.txt) ## Treatment metadata - Omeprazole — 20 mg — oral.solid - Pantoprazole — 40 mg — oral.solid - Esomeprazole — 20 mg — oral.solid - Referral & safety-netting (no drug therapy) - Famotidine — 20 mg — oral.solid - Sucralfate — 1000 mg — oral.solid - Sodium alginate + Sodium bicarbonate + Calcium carbonate — 500 mg — oral.liquid - Baclofen — 10 mg — oral.solid ## Complete treatment card ```text GASTRO-OESOPHAGEAL REFLUX DISEASE (GERD) Sources: ACG Management of GERD 2022 for the indication, with the dose from Baclofen 10 mg Tablets SmPC section 4.2 (eMC product 102514), which titrates "5mg three times a day for three days", then "10mg three times a day for three days", then "15mg three times a day for three days", then "20mg three times a day for three days". The SmPC's only indication is spasticity, so use in reflux is off-label and rests on the ACG guideline, which is not held in this corpus. · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 · ACG Management of GERD 2022 · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (famotidine monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (esomeprazole monograph) · Gaviscon Double Action Aniseed Oral Suspension SmPC section 4.2 (eMC product 685) · Sucralfate 1 g tablets US prescribing information, Dosage and Administration (DailyMed, Amneal Pharmaceuticals NY LLC) Review status: REVIEWED against ACG Management of GERD 2022 for the indication, with the dose from Baclofen 10 mg Tablets SmPC section 4.2 (eMC product 102514), which titrates "5mg three times a day for three days", then "10mg three times a day for three days", then "15mg three times a day for three days", then "20mg three times a day for three days". The SmPC's only indication is spasticity, so use in reflux is off-label and rests on the ACG guideline, which is not held in this corpus., ACG Management of GERD 2022, Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (famotidine monograph), Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (esomeprazole monograph), Gaviscon Double Action Aniseed Oral Suspension SmPC section 4.2 (eMC product 685), Sucralfate 1 g tablets US prescribing information, Dosage and Administration (DailyMed, Amneal Pharmaceuticals NY LLC), Gastro- oesophageal reflux disease (GERD) - disease-level clinical article (gerd-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (11) - Heartburn is a retrosternal burning within 60 minutes of eating, often brought on by exercise or lying down [heartburn] - The pain often starts in the epigastrium and radiates up toward the neck - Acid regurgitation feels like sour or burning fluid reaching the throat or mouth, and straining can bring it on [regurgitation] - About 30% with reflux esophagitis have difficulty swallowing, linked to strictures, Schatzki rings, or weak peristalsis [difficulty swallowing · heartburn · stricture] - A lump-in-the-throat feeling or extra saliva triggered by esophageal acid can also occur - Hoarseness, nausea, abdominal pain, or dyspepsia alone, without heartburn or regurgitation, are unlikely to be reflux [abdominal pain · hoarseness · indigestion · nausea] - Atypical presentations include chest pain that can mimic cardiac disease and a persistent cough [chest pain · cough] - Extraesophageal effects can include vocal hoarseness, sore throat, or laryngospasm [hoarseness · sore throat] - Alarm features are trouble swallowing, pain on swallowing, anaemia, weight loss, vomiting blood, and black tarry stool [anaemia · difficulty swallowing · painful swallowing · vomiting blood · weight loss] - It can complicate into bleeding from the upper gut, anaemia, a narrowed gullet, and Barrett oesophagus [anaemia · bleeding] - Outside the gut it can show as dental erosion, laryngitis, cough, asthma or sinusitis [cough] SIGNS - what you find (1) - Exam can show epigastric tenderness, wheeze or rhonchi, laryngoscopic pharyngitis, or dental erosions, though it is often normal [abdominal pain · epigastric pain · wheeze] TESTS (5) - Dysphagia, odynophagia, marked weight loss, GI bleeding, or anorexia should prompt testing rather than an empiric PPI trial - Ambulatory pH monitoring, done off PPI for at least a week, is the only test that quantifies abnormal acid exposure and reflux frequency - Endoscopy is indicated for overweight patients, those 50 or older, or reflux lasting over 5 years, besides alarm symptoms - The Los Angeles grading runs from small under-5mm mucosal breaks in grade A to breaks over 75% of the circumference in grade D - Barium studies do not correlate with 24-hour pH monitoring results and are not useful for diagnosing reflux IF NOT THIS - what else fits (10) - Coronary artery disease - Infectious esophagitis - Eosinophilic esophagitis - Esophageal motility disorders - Benign esophageal stricture - Esophageal cancer - Peptic ulcer disease - Gastroparesis - Gastric cancer - Biliary colic Source StatPearls "Gastroesophageal Reflux Disease (GERD)" - disease-level clinical article Status traced to the source above Rx: Acid suppression | Main treatment | In pregnancy | On-demand relief | Refractory add-on ACID SUPPRESSION - choose one 1. OMEPRAZOLE [1st line] Adult 20 mg once daily 30-60 min before breakfast x 4-8 weeks Peds Over 1 year: 10-20 mg daily under specialist care (Licensed in children over 1 yr: 10-20 mg daily under specialist care) Choice Alternatives, all proton pump inhibitors. Omeprazole is the cheapest and the reference agent the others are compared against. Source ACG Management of GERD 2022 Why Proton pump inhibitor that suppresses gastric acid production to allow oesophageal mucosal healing and relieve reflux symptoms; first-line pharmacological therapy for GERD. Caution Long-term use (>1 yr) is associated with hypomagnesaemia and fracture risk. Re-evaluate need for continued therapy at 8 weeks. There is an increased risk of Clostridioides difficile diarrhoea. Egypt OMEGASTAZOLE 20MG 14 CAPS. RIVA PHARMA S... 18.00 EGP (1.29/unit) OMEPRAL 20MG 14 CAPS. MEMPHIS 32.00 EGP (2.29/unit) RISEK 20 MG 28 CAPS. JULPHAR 75.00 EGP (2.68/unit) OMISEC 20MG 14CAPS. THE UNITED PH... 42.00 EGP (3.00/unit) EPIRAZOLE 20MG 14CAPS. EIPICO 44.00 EGP (3.14/unit) OMEPAK 20 MG 14 CAPS. SEDICO 50.00 EGP (3.57/unit) RISEK 20 MG 14 CAPS. JULPHAR 57.00 EGP (4.07/unit) NAPIZOLE 20MG 14 CAPS. GLOBAL NAPI P... 62.00 EGP (4.43/unit) 2. PANTOPRAZOLE [1st line] Adult 40 mg once daily before breakfast x 4-8 weeks Peds Specialist use only in children Source ACG Management of GERD 2022 Why Alternative proton pump inhibitor with the same acid-suppressing mechanism as omeprazole, offered as a second PPI option for patients who need a change of agent or have specific tolerability or interaction concerns. Caution Swallow tablet whole - do not crush or chew. Caution in severe hepatic impairment (max 20 mg/day). Long-term PPI cautions apply. Egypt PEPTOLOC 40MG 14 TAB. KAHIRA > MULT... 35.00 EGP (2.50/unit) PEPTOLOC 40MG 7 TAB. KAHIRA > MULT... 21.00 EGP (3.00/unit) PERLOC 40MG 14 F.C.TAB. EUROPEAN EGYP... 75.00 EGP (5.36/unit) PANTOLOC 40MG 14 TAB. MUP 102.00 EGP (7.29/unit) DELPANTO 40MG 14 E.C.TABS. DELTA PHARMA 84.00 EGP PANTAZOL 40MG 14 ENTERIC COATED TAB. SIGMA > SOVALUE PHARMA 104.00 EGP ZURCAL 40 MG 28 GASTRO-RESISTANT TABS. AUG PHARMA 192.00 EGP PANTOMEDRA 40 MG 28 E.C. TABS. AL ROWAD PHAR... 208.00 EGP 3. ESOMEPRAZOLE [1st line] Adult 20 mg once daily for symptomatic GERD without oesophagitis; 40 mg once daily for erosive reflux oesophagitis; 20 mg once daily for long-term maintenance after healing x 4 weeks, extended by a further 4 weeks if not healed; maintenance 20 mg daily thereafter Peds 1 to 11 years: 10 mg once daily at 10 to 20 kg; 10 mg or 20 mg once daily at 20 kg or more; up to 8 weeks. Doses above 1 mg/kg/day have not been studied. 12 years and over: The adult dose. (Licensed from 1 month as granules or powder for oral suspension. Children 1-11 years: 10 mg once daily if 10-20 kg; 10 mg or 20 mg once daily if 20 kg or more; up to 8 weeks. Doses above 1 mg/kg/day have not been studied. Adolescents 12 years and over use the adult dose.) Source Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (esomeprazole monograph) Why 74 live Egyptian products - the single largest orphan on the list. The formulary's first listed indication for esomeprazole is GERD, with separate doses for symptomatic disease, erosive oesophagitis and maintenance. Caution Re-assess the need for continued PPI therapy at 8 weeks and step down to the lowest effective dose. Long-term use is associated with hypomagnesaemia, vitamin B12 malabsorption and fracture risk. Increases the risk of Clostridioides difficile diarrhoea. Reduces absorption of atazanavir, erlotinib and rilpivirine - check the drug list before adding. Take 30-60 minutes before breakfast; swallow gastro-resistant tablets whole. Egypt ESMOPROTON 20 MG 20 CAPS. WADI EL-NEEL ... 42.00 EGP (2.10/unit) ORGIXIUM 20 MG DR 21 CAPS. EGPI > ORIGIN... 49.50 EGP (2.36/unit) BIORAZO 20MG 14 CAPS. BIOPHARM EGYP... 42.00 EGP (3.00/unit) ATMIPRAZOLE 20 MG 20 CAPS. ATCO PHARMA >... 75.00 EGP (3.75/unit) ESOVAXOLE 20 MG 28 CAPS. BIOMED 152.00 EGP (5.43/unit) ESMATAC 20 MG 14 D.R. CAPS. EGPI 55.00 EGP EZOGAST 20MG 14 DELA. REL. CAPS. OCTOBER PHARM... 122.00 EGP ESMOPUMP 20 MG 14 E.C.TABS. ORGANOPHARMA ... 162.00 EGP 4. FAMOTIDINE [2nd line] Adult 20 mg BID (up to 40 mg BID for severe reflux) x 4-8 weeks Peds Specialist use in pediatric reflux Source Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (famotidine monograph) Why Histamine H2-receptor antagonist that reduces gastric acid secretion by a different mechanism than the PPIs above; offered as a second-line or step-down option for GERD, though tolerance can develop with continued use. Caution Tachyphylaxis (tolerance) can develop within 2 weeks of use. Reduce dose in renal impairment. CNS side effects (confusion, headache) are more common in the elderly. Egypt FAMOTAK 20MG 20 F.C.TAB. SEDICO 28.00 EGP (1.40/unit) GASTRODOMINA 20MG 20 TAB. MUP > ALMIRAL... 28.00 EGP (1.40/unit) ANTODINE 20 MG 30 F.C.TABS. AMOUN 60.00 EGP (2.00/unit) FAMOTIN 20MG 20TAB. MEMPHIS 40.00 EGP (2.00/unit) RANI-F 20MG 6 SACHETS PHARCO 42.00 EGP MAIN TREATMENT 5. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Gastro-oesophageal reflux disease (GERD) - disease-level clinical article (gerd- clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Alarm symptoms (dysphagia, odynophagia, significant weight loss, gastrointestinal bleeding, anorexia) require prompt diagnostic evaluation rather than empiric therapy. IN PREGNANCY 6. SUCRALFATE [2nd line] Adult 1 g four times daily on an empty stomach - while symptoms persist in pregnancy Peds Safety and effectiveness in children have not been established on the label. Source Sucralfate 1 g tablets US prescribing information, Dosage and Administration (DailyMed, Amneal Pharmaceuticals NY LLC) Why ACG 2022 lists sucralfate with antacids and alginates as first-line for reflux in pregnancy when lifestyle change fails, and says plainly that outside pregnancy there is little to recommend it. Reflux in pregnancy is a weekly consultation. The dose is the label's duodenal-ulcer dose - the label carries no GERD indication. Caution Off-label here. The label carries one indication - active duodenal ulcer - and GERD is not on it. It is used in pregnancy because it is not absorbed, which is a good reason, but it is not a licensed one. This option is for pregnancy. ACG says there is little to recommend sucralfate in GERD outside pregnancy - do not use it as a general alternative to a PPI. The label's licensed indication is duodenal ulcer; GERD use rests on the ACG guideline, not on the label. It is largely unabsorbed and has no systemic toxicity, which is the point in pregnancy. It binds other drugs - separate it by 2 hours from quinolones, tetracyclines, levothyroxine, phenytoin and digoxin. Four times daily on an empty stomach is a hard regimen to keep to; say so when you write it. Egypt GASTROFAIT 1 GM 20 TAB. EIPICO 70.00 EGP (3.50/unit) SUCROFILMPAN 1GM/5ML ORAL SUSP. 120ML PANAX PHARMA 8.00 EGP -> ? strength differs, ? different route - not oral solid ON-DEMAND RELIEF - give alongside 7. SODIUM ALGINATE + SODIUM BICARBONATE + CALCIUM CARBONATE[add-on - not a substitute] Adult 10-20 mL after meals and at bedtime, up to four times a day - as-needed, alongside or after a PPI course Peds 12 years and over use the adult dose. Under 12 years only on medical advice - the label gives no paediatric dose. Source Gaviscon Double Action Aniseed Oral Suspension SmPC section 4.2 (eMC product 685) Why The ACG 2022 GERD guideline places antacids and alginates as the on-demand symptom- relief layer, and specifically credits an alginic acid preparation with efficacy in symptom relief. A PPI takes days; this is what the patient takes tonight, and what covers breakthrough symptoms once the PPI is stepped down. Strength is quoted as sodium alginate per 10 mL dose. Caution On-demand relief only - it does not heal oesophagitis and does not replace a PPI in erosive disease. High sodium content; take care in a patient on a strict salt restriction or in renal insufficiency. Contains calcium carbonate - caution in hypercalcaemia, nephrocalcinosis and recurrent calcium renal stones. Leave 2 hours between this and tetracyclines, fluoroquinolones, iron salts, thyroid hormones and chloroquine. Egypt GAVISCON DOUBLE ACTION SUSP 150 ML RECKITT BENCKISER HEALTHCARE > UNITED... 144.00 EGP -> ? strength differs GAVISCON DOUBLE ACTION 24 SACHETS*10 ML RECKITT BENCKISER HEALTHCARE > U... 288.00 EGP -> ? strength differs GAVISCON LIQUID 24 SACHETS*10 ML RECKITT BENCK... 288.00 EGP [? strength differs] REFRACTORY ADD-ON - give alongside 8. BACLOFEN [add-on - not a substitute] Adult 5-20 mg three times a day - a time-limited trial, reviewed for benefit Peds Not a paediatric GERD drug. The ACG recommendation is for adults with objectively documented refractory reflux. Source ACG Management of GERD 2022 for the indication, with the dose from Baclofen 10 mg Tablets SmPC section 4.2 (eMC product 102514), which titrates "5mg three times a day for three days", then "10mg three times a day for three days", then "15mg three times a day for three days", then "20mg three times a day for three days". The SmPC's only indication is spasticity, so use in reflux is off-label and rests on the ACG guideline, which is not held in this corpus. Why ACG 2022 states that a trial of baclofen at 5-20 mg three times a day can be considered where reflux is objectively documented to continue despite optimal PPI therapy. It is a 'consider' rather than a recommendation, and it is a post-investigation drug, not a primary-care first move. Caution Only after objective documentation of continued reflux on optimal PPI therapy - not for a patient whose symptoms simply have not settled. ACG notes a randomised trial found no significant benefit over placebo at 1 year, though it was underpowered. Limited by dizziness, somnolence and constipation. Do not stop abruptly after prolonged use. Egypt MYLOBAC 10MG 20 TAB. PHAROPHARMA 28.00 EGP (1.40/unit) BACLOFEN 10 MG 20 TABS. MISR > AL DEL... 30.00 EGP (1.50/unit) SPINOBAC 5MG/5ML SYRUP 120ML SAJA PHARMACE... 39.00 EGP -> ? strength differs, ? different route - not oral solid SPINOBAC 5MG/5ML SYRUP 300ML SAJA PHARMACE... 73.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)