MP PPI

PPIs are typically prescribed for 4 to 8 weeks as empiric therapy to relieve symptoms of GERD. PPI on-demand therapy for GERD symptoms was added to the treatment options in 2017.1 PPI maintenance therapy should be considered in patients with certain conditions—such as erosive esophagitis, eosinophilic esophagitis, Barrett esophagus, and Zollinger-Ellison syndrome—and in those on antiplatelet therapy or nonsteroidal anti-inflammatory drugs who are at high risk for ulcer-related bleeding.1 Implementing lifestyle modifications from the time of GERD diagnosis may also improve symptoms if a clear dietary trigger had been found to exacerbate symptoms.

In conclusion, it is important for physicians to perform medication reconciliations with patients at every visit to assess the need for PPIs, to evaluate the most effective dosage, and to address any medication interactions. If patients are hesitant to initiate PPI therapy, they can be reassured of the low adverse event rate for long-term use. Alternatively, therapy can be stepped down to a cheaper H2 blocker or even on-demand treatment, such as OTC antacids. Discontinuing treatment all together would likely worsen patients’ symptoms and carry a risk of developing other conditions. Physicians should take these points into consideration when discussing treatment options with patients