GERD treatment

prn and prophylaxis

• BID for 6-12 weeks for mild symptoms
• higher dose or QID for used for erosive disease (not cost effective compared to PPIs)

dec gastric acid secretion and gastric volume by inhibiting binding of histamine on H2 receptor of parietal cell

QID or BID for 8-12 wks

heartburn that happens 2 or more times a week.

take daily (not effective for prn use)

irreversible binding to HK ATPase pumps of the parietal cells - inhibits the final step of gastric acid secretion

in about 4 days

daily for 14 days

daily for 4-8 wks

daily or BID for 4-16 wks

BID for 4 weeks initially

• promotility agent
• cholinergic stimulant
• increases LES
• increases esophageal clearance

• dopamin antagonist
• increases LES
• accelerates gastric emptying

• promotility
• facilitates Ach release resulting inc in LES pressure and accelerated gastric emptying

limited value; similar in efficacy to H2 blockers in mild esophagitis

pts with complications like strictures, hemorrhage, Barrett's esophagus, and recurrence of residual symptoms after healing

DOC: PPIs

• 1. atypical symptoms
• 2. alarm symptoms
• 3. children under 12 yo
• 4. failure of OTC therapy

• chest pain that mimics angina
• non allergic asthma
• chronic cough
• hoarseness
• pharyngites
• dental erosion

• dysphagia (difficulty swallowing)
• odynophagia (painful swallowing)
• unexplained weight loss
• GI bleeding