NICE guidelines

NICE guidelines. The National Institute for Health and Care Excellence, issues help and guidance on many issues relevant to acid reflux treatment available from their site here.

Dyspepsia and gastro‑oesophageal reflux disease: Investigation and management of dyspepsia, symptoms suggestive of gastro‑oesophagealreflux disease, or both.

This guidance (published September 2014) includes the following:

    • The community pharmacist
    • Common elements of care
    • Referral guidance for endoscopy
    • Interventions for uninvestigated dyspepsia
    • Reviewing patient care
    • Interventions for gastro-oesophageal reflux disease (GORD)
    • Interventions for peptic ulcer disease
    • Interventions for functional dyspepsia
    • Helicobacter pylori testing and eradication
    • Laparoscopic fundoplication
    • Referral to a specialist service
    • Surveillance for people with Barrett's oesophagus

And includes an options grid to help patients and healthcare professionals talk about options for treating heartburn that lasts longer than 4 weeks. (Downloadable at the bottom of this page.)

Much interest is being shown in new treatment options. Read NICE guidelines on them here:

RFA (Endoscopic Radio Frequency Ablation for Barrett's Oesophagus with low grade dysplasia or no dysplasia)

"Current evidence on the efficacy of endoscopic radiofrequency ablation for Barrett's oesophagus with low‑grade dysplasia is adequate provided that patients are followed up in the long term. There are no major safety concerns. Therefore, this procedure may be used in patients with Barrett's oesophagus with low‑grade dysplasia with normal arrangements for clinical governance, consent and audit or research."

"Current evidence on the efficacy and safety of endoscopic radiofrequency ablation for Barrett's oesophagus with no dysplasia is limited in quality and quantity. Therefore, this procedure should only be used in patients with no dysplasia in the context of research."

LINX - ring of magnetic beads (a bracelet) for lower oesophageal sphincter augmentation.

"The evidence on the safety and efficacy of laparoscopic insertion of a magnetic bead band for gastro-oesophageal reflux disease (GORD) is limited in quantity. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research."

TIF - Transoral Incissionless Fundoplication (Endoluminal gastroplication)"The evidence on endoluminal gastroplication for gastro-oesophageal reflux disease (GORD) raises no major safety concerns. Evidence from a number of randomised controlled trials (RCTs) shows a degree of efficacy in terms of reduced medication requirement in the short term, but changes in other efficacy outcomes are inconsistent and there is no good evidence of sustained improvement in oesophageal pH measurements. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research."

Endostim ("Pacemaker for the Lower Oesophageal Sphincter")

"NICE has been notified about the above procedure and are currently undertaking preliminary investigations, with the aim of assessing whether this procedure falls within the remit of the Interventional Procedures Programme."