Gastroesophageal reflux therapy

The most useful tool in the diagnosis of gastroesophageal reflux is the clinical history, including both presenting symptoms and associated risk factors. Patients with mild, typical reflux symptoms do not usually require invasive evaluation a clinical diagnosis of GERD can be assumed in patients who respond to appropriate therapy. 

Field SK, Sutherland LR Does medical antireflux therapy improve asthma in asthmatics with gastroesophageal reflux a critical review of the htera-ture. Chest 1998 114 275-283. 

Symptomatic gastroesophageal reflux - Short-term (4 to 12 weeks) therapy for adults with symptomatic documented gastroesophageal reflux who fail to respond to conventional therapy. 

Symptomatic gastroesophageal reflux 10 to 15 mg orally up to 4 times daily 30 minutes before each meal and at bedtime. If symptoms occur only intermittently or at specific times of the day, single doses up to 20 mg prior to the provoking situation may be preferred rather than continuous treatment. Occasionally, patients who are more sensitive to the therapeutic or adverse effects of metoclopramide (eg, elderly) will require only 5 mg/dose. Guide therapy directed at esophageal lesions by endoscopy. Therapy longer than 12 weeks has not been evaluated and cannot be recommended. 

Healed duodenal ulcer, gastroesophageal reflux disease PO 15 mg/day Helicobacter pylori infection PO (Triple drug therapy) 30mgql2hfor 1 OH 4 days. PO (Dual drug therapy) 30 mg q8h for 14 days. 

Katz P Medical therapy for gastroesophageal reflux disease in 2007. Rev Gastroenterol Disord 2007 7 193. [PMID 18192955]... 

IV form is indicated for short-term treatment (7 to 10 days) of gastroesophageal reflux disease (GERD), as an alternative to oral therapy in patients who are unable to continue taking the oral form. Safety and efficacy of injectable form as an initial treatment for GERD have not been demonstrated. 

He was hospitalized for revision of his arteriovenous shunt and postoperatively complained of symptoms of gastroesophageal reflux. This complaint prompted institution of cimetidine therapy. In view of the patient s impaired renal function, the usually prescribed dose was reduced by half. Three days later, the patient was noted to be confused. An initial diagnosis of dialysis dementia was made and the family was informed that dialysis would be discontinued. On teaching rounds, the suggestion was made that cimetidine be discontinued. Two days later the patient was alert and was discharged from the hospital to resume outpatient hemodialysis therapy. 

The effect of cisapride 0.2 mg/kg tds for 8 weeks on cardiac rhythm was studied in a placebo-controUed, double-blind trial in 49 children aged 0.5 years with gastroesophageal reflux resistant to other medical therapy (14). None had underlying cardiac disease or electrolyte imbalance. Cisapride had no effect on cardiac electrical function. However, in a prospective study cisapride 2 mg/kg qds given for 72 hours to 10 premature infants caused a significant increase in the QTc interval compared with pretreatment values (15). 

Pashankar D, Blair GK, Israel DM. Omeprazole maintenance therapy for gastroesophageal reflux disease after failure of fundoplication. J Pediatr Gastroenterol Nutr 2001 32(2) 145-9. 

Condra LJ, Morreale AP, Stolley SN, Marcus D. Assessment of patient satisfaction with a formulary switch from omeprazole to lansoprazole in gastroesophageal reflux disease maintenance therapy. Am J Manag Care 1999 5(5) 631-8. 

Ranitidine is indicated for therapy of peptic ulcer disease, gastroesophageal reflux disease, pathological hypersecretory conditions (e.g., Zollinger-Ellison syndrome), erosive esophagitis, and adjunctive treatment of acute allergic reactions. 

Theodoropoulos DS, Lockey RF, Boyce HW Jr, Bukantz SC Gastroesophageal reflux and asthma A review of pathogenesis, diagnosis, and therapy. Allergy 1999 54 651-661. (Ila)... 

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