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''Symptoms''
Heartburn and Acid regurgitation
also - chest pain, globus pharyngeus, resp (cough), ENT (dysphonia, post drip, throat clear) 

''worry / refer''
IF - over 40, dysphagia, pain on swallowing, wt loss, anaemia, dark stool, 
OR - FH, n&v, nocturnal Sx

''Mx '' - aim to relieve Sx, heal tissue, prevent complications / relapse
''Behaviour modify''
raise end of bed by 15 cms
beware - fatty, citrus, alcohol, chocolate, tomato, coffee, mint
Drugs - anticholinergics, theophylline, CCB, tricyclics, BB, alendronate
stop smoking, loose weight, small meals, don't lie down for 2 hrs post food

''PPI''
relieve Sx and heal oesophagus faster than H2
use full dose 6-12/52 then on demand
NICE says use for severe disease - H2 for mild
SE - d&v&n, also dry mouth / taste disturbance, rarely peripheral oedema, interstitial nephritis
Occ metoclopramide used for Sx but beware Parkinsonism long term

''Relapse''
Not fully understood - only 15% oesophagitis progress, but 80% relapse off drugs
use PPI to maintain at lowest dose possible to relieve Sx (or H2 if PPI not tolerated)
refer for surgery - if high does needed to maintain Sx according to clinical condition of pt

''DD''
Peptic ulcer
gastritis
cancer
drugs - beware - Theophylline, ISMnitrate, Nifedipine, NSAID

''Surgery'' - fundoplication
useful for chronic severe unresponsive to PPI
?refer if complications - stenosis . ulcer . barretts
?? may help with resp Sx eg asthma - ? improves Sx but not pulmonary function ??

''Endoscopic treatment ''- not recommended

''In pregnancy''
30-50% women c/o heartburn, 
oesophagitis is usually mild
resolves soon after delivery
lifestyle advice, then antacids or H2, NOT PPI usually