Gastroesophageal Reflux Disease (GERD)


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Indications for Antireflux Surgery ÎPresently, endoscopic therapy has no role in GERD treatment. ÎAntireflux surgery, performed by an experienced surgeon, is recommended for patients with: > Persistent troublesome symptoms, especially troublesome regurgitation, despite PPI* therapy with positive impedance + pH. (II) Remark: The potential benefits of antireflux surgery should be weighed against the deleterious effect of new symptoms consequent upon surgery, particularly dyspha- gia, flatulence, an inability to belch, and postsurgery bowel symptoms. > GERD responsive to acid suppressive therapy. (II) ÎAntireflux surgery is not recommended as an antineoplastic measure in patients with Barrett's metaplasia. Table 1. Treatment Regimens for GERD Class/Agent PPIs* Adult Dose Dexlansoprazole Dexilant® (formerly Kapidex®) Esomeprazole Nexium® Lansoprazole Prevacid® Omeprazole Prilosec® Zegerid® (omeprazole+bicarbonate) Pantoprazole Protonix® Rabeprazole Aciphex® H2RAs Cimetidine Tagamet® Famotidine Pepcid® Nizatidine Axid® Ranitidine Zantac® Peristalsis stimulant Metoclopromide Reglan® Metozolv® ODT Alginic acid Gaviscon® 10-15 mg PO up to qid 30 minutes before each meal and at bedtime Antacids plus Numerous combinations OTC liquid and tablets OTC liquid and tablets Headache, restlessness, drowsiness, fatigue, lassitude, nausea, diarrhea Constipation, diarrhea Nausea, vomiting, constipation, anorexia, dysgeusia 30-60 mg daily PO 20-40 mg daily PO or IV 15-30 mg daily PO 20 mg daily PO 20-40 mg daily PO 40 mg daily PO or IV 20 mg daily PO 800 mg bid or 400 mg qid PO; 300 mg q6-8h IM or IV 20-40 mg bid PO; 20 mg q12h IV 150 mg bid PO 150 mg or 10 mL of syrup bid PO Headache, dizziness, constipation, diarrhea, abdominal pain, nausea, vomiting Diarrhea, abdominal pain, nausea, vomiting, regurgitation, constipation, upper respiratory tract infection, cough, flatulence, headache, somnolence, dizziness, asthenia, back pain, rash Common Side Effects

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