Fast Five Quiz: Esophagitis

B.S. Anand, MD


July 14, 2020

Previously, histamine-2 receptor antagonist therapy was recommended as the initial treatment for esophagitis associated with GERD; however, subsequent studies of cost-effectiveness and symptom relief suggested that PPIs are superior.

AGA guidelines for long-term PPI use recommend the following:

  • Patients with uncomplicated GERD who respond to short-term PPIs should subsequently attempt to stop or reduce them. Patients who cannot reduce PPIs should consider ambulatory esophageal pH/impedance monitoring before committing to lifelong PPI therapy, to help distinguish GERD from a functional syndrome.

  • Patients at high risk for ulcer-related bleeding from nonsteroidal anti-inflammatory drugs (NSAIDs) should take a PPI, if they continue to take NSAIDs.

  • The dose of long-term PPIs should be periodically reevaluated so that the lowest effective PPI dose can be prescribed to manage the condition.

  • Long-term PPI users should not routinely use probiotics to prevent infection.

  • Long-term PPI users should not routinely raise their intake of calcium, vitamin B12, or magnesium beyond the recommended dietary allowance.

  • Long-term PPI users should not routinely screen or monitor bone mineral density, serum creatinine levels, magnesium levels, or vitamin B12 levels.

  • Specific PPI formulations should not be selected on the basis of potential risks.

Read more about PPI use in patients with esophagitis.


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