GASTROENTEROLOGY ARTICLE OF THE WEEK
February 26, 2009
AGA Position Statement Management of Gastroesophageal reflux. Gastroenterology 2008;135:1383-1391.
1. Regarding maintenance therapy for esophagitis (erosive disease)
a. should be avoided due to long-term effects of PPI
b. should be kept at the dose that was needed to heal mucosa
c. should be titrated down to the lower effective dose based on symptom control
d. can be titrated down to qod or tiw if symptoms are controlled
e. can be switched to
“on-demand” therapy based on symptoms only
True or False
2. Extraesophageal
reflux syndromes should be treated with BID PPI for 2-4 months, based on expert
consensus, not data.
3. For patients needing short-course acid suppression for episodic GERD, H2RA are more effective than PPI’s
4. The
pharmacology of most PPI’s clearly support bid dosing for maximal acid
suppression
5. According to these guidelines, pH monitoring should be done off acid suppression for patients who do not respond to bid PPI
6. BID PPI therapy is recommended as initial therapeutic trial for patients with reflux-chest pain syndrome after cardiac etiology is excluded
7. Patients with GERD who have a normal EGD are very unlikely to progress to erosive disease with time, making serial EGD’s not necessary
8. EGD to screen for Barrett’s in the setting of GERD is not routinely recommended
9. PPI-related side effects such as headache and diarrhea may resolve when switching to other PPI
10. Anti-reflux
surgery should be recommended to individuals with GERD who are well controlled
on long-term PPI’s to avoid PPI-related side effects