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Contact your GP or prescribing clinician if you experience: Heartburn that persists despite lifestyle modifications and over-the-counter treatments Difficulty swallowing (dysphagia) Pain when swallowing (odynophagia) Unintentional weight loss beyond expected therapeutic effect Persistent vomiting, particularly if containing blood or resembling coffee grounds Black, tarry stools (melaena) suggesting gastrointestinal bleeding Severe, persistent abdominal pain Symptoms of anaemia (fatigue, pallor, breathlessness) Seek immediate medical attention (call 999 or attend A&E) if you develop: Severe chest pain, particularly if radiating to the arm, neck, or jaw (to exclude cardiac causes) Vomiting large amounts of blood Sudden, severe abdominal pain Signs of dehydration from persistent vomiting According to NICE guidance on gastro-oesophageal reflux disease (CG184), patients with persistent reflux symptoms lasting more than 48 weeks despite optimal treatment should be considered for further investigation