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©The Author(s) 2022.
World J Gastroenterol. Jun 28, 2022; 28(24): 2667-2679
Published online Jun 28, 2022. doi: 10.3748/wjg.v28.i24.2667
Published online Jun 28, 2022. doi: 10.3748/wjg.v28.i24.2667
ACG/ACG/CAG/SAGES/European guidelines | Recommendation |
GERD[19,20,22] | Trial an 8-wk duration of once daily PPI in patients with heartburn and regurgitation without reflux symptoms |
Once daily dosing-administer PPIs 30 min to 1 h before a meal; twice daily dosing-administer PPIs 30 min to 1 h before breakfast and dinner | |
For patients experiencing refractory GERD, optimize PPI therapy with patient compliance, dosage and timing to achieve symptom control before further exploration | |
Prescribe continuous daily PPIs over H2RAs for erosive esophagitis maintenance healing | |
Continue lifelong PPIs in patients with LA Grade C or D erosive esophagitis | |
If patients with normal esophageal mucosa or LA Grade A esophagitis have normal ambulatory reflux monitoring results after 2-4 wk discontinuation of PPI therapy, it is strongly recommended to stop PPI use (low level of evidence) | |
Dyspepsia[23] | Patients < 60 years old, tested H. pylori negative or symptoms persist after eradication therapy, should start empiric PPI therapy |
Functional dyspepsia patients, tested H. pylori negative or symptomatic after infection treatment, should be on PPIs | |
H. pylori infection[24] | If active or history of PUD, and tested H. pylori positive, start eradication treatment (10-14 d) with PPIs and antibiotics |
Dyspepsia patients found to be H. pylori positive on gastric biopsy, treat with eradication therapy consisting of PPIs and antibiotics for 10-14 d | |
GERD patients who are found H. pylori positive should be offered eradication therapy for 10-14 d course | |
Use levofloxacin triple regimen consisting of PPI, amoxicillin and levofloxacin as salvage therapy if first line eradication therapy fails | |
Barrett’s esophagus[25, 26] | Recommend once daily dosing PPIs primarily indicated for symptomatic relief |
Twice daily dosing can be considered in patients with esophagitis or poor symptomatic relief | |
EoE [28,29] | Recommend PPI therapy for clinical and histological remission of EoE |
NSAIDs[31,32] | PPIs are indicated for patients at risk of GI bleeds for gastroprotection (age > 65 years, high dose NSAID use, previous history of ulcers, concomitant therapy with corticosteroids, anticoagulants and antithrombotics) |
Prescribe continuous or intermittent high dose PPI the following 3 d after GI ulcer bleed was stopped endoscopically |
- Citation: Turshudzhyan A, Samuel S, Tawfik A, Tadros M. Rebuilding trust in proton pump inhibitor therapy. World J Gastroenterol 2022; 28(24): 2667-2679
- URL: https://www.wjgnet.com/1007-9327/full/v28/i24/2667.htm
- DOI: https://dx.doi.org/10.3748/wjg.v28.i24.2667