Esomeprazole and omeprazole.
The incidence increases with age.
The PPI dose and frequency should be tapered slowly.
Antacids.
McGraw-Hill.
Rebound gastric acid hypersecretion.
They are formulated in delayed-release capsules or tablets.
5th edition.
Gastroesophageal reflux disease, defined as troublesome symptoms and/or complications caused by refluxing of stomach contents into the esophagus.
In case of typical symptoms and a positive response to a trial of acid-suppressing therapy.
Understanding the causes of GERD is essential for effective management.
Increasing the pH of gastric contents.
Clinical history, including symptoms and risk factors.
A short-term (maximum 2-week) course of nonprescription PPI therapy.
Foods and medications that may worsen GERD symptoms.
Reduced absorption of calcium, magnesium, and vitamin B12.
Dyspepsia, often occurring with peptic ulcer disease.
Lifestyle modification, compliance, adverse effects, and drug-drug interactions.
PPIs (Proton Pump Inhibitors).
They are short-acting and require frequent administration for continuous acid neutralization.
Prokinetic agents.
PPIs should be tapered gradually and slowly.
Fluoroquinolones, tetracyclines, iron products, and thyroid hormones.
In case of extraesophageal symptoms.
A nonabsorbable aluminum salt of sucrose octasulfate.
Esophageal manometry.
To neutralize stomach acid.
Endoscopy.
6th edition.
They are generally well tolerated.
A trial of a scheduled PPI for 8 weeks.
Not recommended.
No, they are not interchangeable.
Appropriate long-term maintenance therapy.
Typical symptoms are common, atypical symptoms are less common, and alarm symptoms indicate serious conditions.
Limited value.
They are used for intermittent treatment of GERD symptoms for immediate, symptomatic relief.
No, it is not warranted based solely on chronic PPI use.
They are primarily renally eliminated.
H2 RAs are more effective than antacids at controlling chronic GERD symptoms.
They can mix the contents of the capsule in acidic juice.
Gastric acid, pepsin, bile acids, and pancreatic enzymes.
Headache, diarrhea, and nausea.
As a delayed-release, orally disintegrating tablet.
Approaches to GERD treatment.
Magnesium hydroxide and/or aluminum hydroxide combination products.
In a capsule sprinkle that can be opened and mixed with soft food like applesauce.
Direct gastric acid neutralization or reducing acid production.
Anatomic factors, esophageal clearance, mucosal resistance, gastric emptying, epidermal growth factor, and salivary buffering.
By inhibiting gastric H+/K+ - adenosine triphosphatase in gastric parietal cells.
They can result in morbidity and decreased work productivity.
Symptoms.
Symptomatic improvement.
Take the PPI prior to the evening meal.
H2RAs (H2 receptor antagonists).
Defective LES pressure or function contributes to GERD.
Dose adjustment may be required.
McGraw-Hill.
Ambulatory esophageal reflux monitoring.
Due to their slow onset of action.
Continued symptoms after 4 - 8 weeks of acid suppressing therapy.
They should be evaluated by a provider.
To block gastric acid secretion.
A low- to moderate overall increased infection risk.
It must be individualized.
In the morning, 30 to 60 minutes before breakfast.
5th edition.
For patients with atypical or alarm symptoms.
Enteric-coated (pH-sensitive) granules in capsule form.
Lower efficacy and more adverse effects.
Esomeprazole and pantoprazole.
H2 RAs are less effective than PPIs.
Anti-reflux surgery.
Daily PPI therapy.
Retrograde movement of acid or other noxious substances from the stomach into the esophagus.
Increasing the pH of gastric contents.
Before the evening meal and not at bedtime.
Nonprescription PPI therapy.
Prior to a meal.
To help maintain the integrity of the enteric-coated pellets until they reach the small intestine.
To use the lowest dose possible to control symptoms and routinely evaluate if long-term therapy is indicated.
Omeprazole.
Empirically to patients with troublesome GERD symptoms.
A trial of proton pump inhibitors (PPIs).
Both pharmacological and non-pharmacological interventions.
Strictures.
No, their use is not recommended.
No, it is not more efficacious and is significantly more expensive.
To alleviate symptoms.
Headache, fatigue, dizziness, and either constipation or diarrhea.
Healing of mucosal injury.
Antireflux surgery.
A method where PPI therapy is stopped upon resolution of GERD symptoms and reinitiated for 2 to 4 weeks if symptoms occur two or more times within 7 days while off therapy.
Adverse drug reactions, drug-drug interactions, and adherence.
If GERD symptoms occur two or more times within 7 days while off therapy.
Patients whose symptoms return once therapy is discontinued or decreased, and patients with refractory symptoms while on maximal acid suppression.
3 months or longer.
It can reduce symptoms by preventing acid reflux.
Eating smaller meals and avoiding food 3 hours before bedtime.
Avoiding alcohol.
A nonprescription trial of self-directed therapy with all three major pharmacologic classes.
They should not crush, chew, or split the delayed-release tablets.
A healthcare provider.
Weight loss if overweight.
Obesity increases abdominal pressure, which is a risk factor for developing GERD symptoms and complications.
Decrease the frequency of recurrent disease.
Omeprazole and lansoprazole.
McGraw-Hill.
Direct gastric acid neutralization or reducing acid production.
No meaningful interaction or increase in the incidence of myocardial infarction in patients using omeprazole with aspirin and clopidogrel.
Antacid composition, dose, schedule, and formulation.
To assess the effectiveness of treatment and improve patient quality of life.
A phenomenon where the response to a drug decreases with repeated doses over time.
Cimetidine, famotidine, nizatidine, and ranitidine.
They are part of patient-directed therapy.
A trial of twice-daily PPIs.
The clinical presentations of the patient.
They may be dosed intermittently or on a scheduled basis.
A delayed-release tablet and a combination product with sodium bicarbonate in an immediate-release capsule and oral suspension (Zegerid®).
Zegerid® (omeprazole with sodium bicarbonate).
Omeprazole.
It creates a viscous barrier that can aid in acid neutralization.
To identify Barrett esophagus, which is associated with an increased risk of esophageal cancer.
Dexlansoprazole and the combination product omeprazole – sodium bicarbonate.
To reduce acid production in the stomach.
To inhibit acid production in the stomach.
Foods or medications that exacerbate GERD.
Designing a monitoring plan for efficacy and safety.
Alginic acid.
To reduce acid production in the stomach.
They decrease acid secretion by inhibiting the histamine2 receptors in gastric parietal cells.
6th edition.
At least 2 months.
H2 RAs are well tolerated.
They maintain the gastric pH above 4, even during acid surges postprandially.
Profound and long-lasting.
Drug interactions with clopidogrel.
As a delayed-release oral suspension powder packet.
Switching to a P2Y12 inhibitor not activated by CYP2C19, switching to a PPI with less CYP2C19 metabolism, or substituting an H2RA for a PPI.
By decreasing their absorption of medications that require an acidic environment.
Dabigatran, encapsulated itraconazole, and dipyridamole.
They can be given as PRN (as needed) or scheduled.
At least 8 weeks of twice-daily PPI therapy.
In patients not responding to an adequate trial of a twice-daily PPI.
The cytochrome P-450 system.
To guide pharmacotherapy for managing GERD.
Antacids are a type of pharmacologic therapy.
They can be mixed with water prior to delivery through a nasogastric tube.
Electrolyte abnormalities, especially in cases of renal impairment.
Typical acute GERD symptoms.
They increase gastric volume and/or decrease gastric emptying.
Yes, even weight gain in patients with a normal body mass index may cause new-onset GERD symptoms.
Prevent complications.
Constipation or diarrhea, depending on the product.
To inhibit acid production in the stomach.
Acid-suppressing therapy.
Smoking cessation.
Yes, they can be administered prophylactically.
