According to NICE guidelines, Dyspepsia symptoms are present for 4 weeks or more and include:-
upper abdominal pain or discomfort, heartburn, gastric reflux, nausea or vomiting. In this guideline, gastro-oesophageal reflux disease (GORD) refers to endoscopically determined oesophagitis or endoscopy-negative reflux disease.
NICE guidelines suggest that we do not routinely offer endoscopy to diagnose Barrett's oesophagus, but consider it if the person has gastro-oesophageal reflux disease (GORD). Discuss the person's preferences and their individual risk factors (for example, long duration of symptoms, increased frequency of symptoms, previous oesophagitis, previous hiatus hernia, oesophageal stricture or oesophageal ulcers, or male gender).
As long as this patient has only short duration of heartburn we can Offer him full-dose for 8 weeks to heal severe
oesophagitis,according to NICE guidelines 2014
In the case he does not respond to medication then we can refer him for endoscopy and offer a full-dose PPI long-term as maintenance treatment for people with severe oesophagitis, taking into account the person's preference and clinical circumstances (for example, tolerability of the PPI, underlying health conditions and possible interactions with other drugs), and the acquisition cost of the PPI.
Another advise we can give him to stop alcohol, avoid NSAID
Nice guidelines states that
Consider referral to a specialist service for people:
of any age with gastro-oesophageal symptoms that are non‑responsive to treatment or unexplained
with suspected GORD who are thinking about surgery
with H pylori that has not responded to second-line eradication therapy.
the person's individual preference
the person's risk factors (for example, male gender, older age and the length of the Barrett's oesophagus segment).
Jaynes M and Kumar A 2019 reviewed many adverse effects of the long-term use of PPIs in different literatures:-
Clostridium difficile (C. difficile) infection
Dementia
Pneumonia
Kidney disease
Micronutrient deficiency
Bone mineral density
References:-
https://www.nice.org.uk/guidance/cg184/chapter/Key-priorities-for-implementation
Jaynes M and Kumar A, 2019. The risks of long-term use of proton pump inhibitors: a critical review.Ther Adv Drug Saf. 10: 2042098618809927