chronic

Gastro-oesophageal reflux disease (GERD)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources7 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 against7 documents

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)

Verified date2026-08

Presentation reference

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

SourceStatPearls "Gastroesophageal Reflux Disease (GERD)" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Acid suppression | Main treatment | In pregnancy | On-demand relief | Refractory add-on

ACID SUPPRESSION - choose one

OMEPRAZOLE

Acid suppression

1st line

Strength20 mg

Formoral.solid

Adult dose and duration

20 mg once daily 30-60 min before breakfast x 4-8 weeks

Paediatric dose

(Licensed in children over 1 yr: 10-20 mg daily under specialist care)

Dose by age
Over 1 year:	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.

Dose 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.

Cautions

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.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
OMEGASTAZOLE 20MG 14 CAPS.	RIVA PHARMA S.A.E.	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 PHARMACEUTICALS CO LTD-JORDAN > MODERN PHARMA	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 PHARMACEUTICALS	62.00 EGP (4.43/unit)

PANTOPRAZOLE

Acid suppression

1st line

Strength40 mg

Formoral.solid

Adult dose and duration

40 mg once daily before breakfast x 4-8 weeks

Paediatric dose

Specialist use only in children

Dose 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.

Cautions

Swallow tablet whole - do not crush or chew.
Caution in severe hepatic impairment (max 20 mg/day).
Long-term PPI cautions apply.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
PEPTOLOC 40MG 14 TAB.	KAHIRA > MULTIPHARMA	35.00 EGP (2.50/unit)
PEPTOLOC 40MG 7 TAB.	KAHIRA > MULTIPHARMA	21.00 EGP (3.00/unit)
PERLOC 40MG 14 F.C.TAB.	EUROPEAN EGYPTIAN PHARM. IND.	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 PHARMACEUTICAL INDUSTRIAL CO. > BIOMED PHARMACEUTICALS	208.00 EGP

ESOMEPRAZOLE

Acid suppression

1st line

Strength20 mg

Formoral.solid

Adult dose and duration

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

Paediatric 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.)

Dose by age
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.

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.

Cautions

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.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
ESMOPROTON 20 MG 20 CAPS.	WADI EL-NEEL BENTA	42.00 EGP (2.10/unit)
ORGIXIUM 20 MG DR 21 CAPS.	EGPI > ORIGIN IN PHARMA	49.50 EGP (2.36/unit)
BIORAZO 20MG 14 CAPS.	BIOPHARM EGYPT > SAJA PHARMA	42.00 EGP (3.00/unit)
ATMIPRAZOLE 20 MG 20 CAPS.	ATCO PHARMA > ATM PHARMACEUTICAL INDUSTRIES	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 PHARMA > COPAD PHARMA	122.00 EGP
ESMOPUMP 20 MG 14 E.C.TABS.	ORGANOPHARMA > ORGANO	162.00 EGP

FAMOTIDINE

Acid suppression

2nd line

Strength20 mg

Formoral.solid

Adult dose and duration

20 mg BID (up to 40 mg BID for severe reflux) x 4-8 weeks

Paediatric dose

Specialist use in pediatric reflux

Dose 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.

Cautions

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.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
FAMOTAK 20MG 20 F.C.TAB.	SEDICO	28.00 EGP (1.40/unit)
GASTRODOMINA 20MG 20 TAB.	MUP > ALMIRALL PRODES-SPAIN	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

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose 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.

Cautions

RED FLAG - Alarm symptoms (dysphagia, odynophagia, significant weight loss, gastrointestinal bleeding, anorexia) require prompt diagnostic evaluation rather than empiric therapy.

IN PREGNANCY

SUCRALFATE

In pregnancy

2nd line

Strength1000 mg

Formoral.solid

Adult dose and duration

1 g four times daily on an empty stomach - while symptoms persist in pregnancy

Paediatric dose

Safety and effectiveness in children have not been established on the label.

Dose 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.

Cautions

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.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
GASTROFAIT 1 GM 20 TAB.	EIPICO	70.00 EGP (3.50/unit)
SUCROFILMPAN 1GM/5ML ORAL SUSP. 120ML? strength differs? different route - not oral solid	PANAX PHARMA	8.00 EGP

ON-DEMAND RELIEF - give alongside

SODIUM ALGINATE + SODIUM BICARBONATE + CALCIUM CARBONATE

On-demand relief

add-on - not a substitute

Strength500 mg

Formoral.liquid

Adult dose and duration

10-20 mL after meals and at bedtime, up to four times a day - as-needed, alongside or after a PPI course

Paediatric dose

12 years and over use the adult dose. Under 12 years only on medical advice - the label gives no paediatric dose.

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.

Cautions

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.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
GAVISCON DOUBLE ACTION SUSP 150 ML? strength differs	RECKITT BENCKISER HEALTHCARE > UNITED PARTNERS	144.00 EGP
GAVISCON DOUBLE ACTION 24 SACHETS*10 ML? strength differs	RECKITT BENCKISER HEALTHCARE > UNITED PARTNERS	288.00 EGP
GAVISCON LIQUID 24 SACHETS*10 ML? strength differs	RECKITT BENCKISER HEALTHCARE > UNITED PARTNERS	288.00 EGP

REFRACTORY ADD-ON - give alongside

BACLOFEN

Refractory add-on

add-on - not a substitute

Strength10 mg

Formoral.solid

Adult dose and duration

5-20 mg three times a day - a time-limited trial, reviewed for benefit

Paediatric dose

Not a paediatric GERD drug. The ACG recommendation is for adults with objectively documented refractory reflux.

Dose source

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.

Cautions

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.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
MYLOBAC 10MG 20 TAB.	PHAROPHARMA	28.00 EGP (1.40/unit)
BACLOFEN 10 MG 20 TABS.	MISR > AL DELTA PHARMACEUTICALS TRADING CO.	30.00 EGP (1.50/unit)
SPINOBAC 5MG/5ML SYRUP 120ML? strength differs? different route - not oral solid	SAJA PHARMACEUTICALS > CLAVITA PHARMA	39.00 EGP
SPINOBAC 5MG/5ML SYRUP 300ML? strength differs? different route - not oral solid	SAJA PHARMACEUTICALS > CLAVITA PHARMA	73.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.