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
