3rd May 2024

A 45-year-old male presents with a 6-month history of heartburn, particularly worsening after meals and when lying down.

A 45-year-old male presents with a 6-month history of heartburn, particularly worsening after meals and when lying down. He reports occasional regurgitation of food and a sour taste in his mouth but no dysphagia, weight loss, or gastrointestinal bleeding. His BMI is 27 kg/m², and he has no significant past medical history. He smokes 10 cigarettes a day and consumes alcohol socially. He has tried over-the-counter antacids with partial relief. An upper GI endoscopy reveals mild oesophagitis.

Which is the most appropriate initial management?