Fast Five Quiz: Gastroesophageal Reflux Disease Management

B.S. Anand, MD

Disclosures

February 12, 2021

With their ability to inhibit gastric parietal cells' H+/K+ ATPase enzyme system, PPIs are the most effective class of GERD medications. However, they can affect cardiac conduction and calcium homeostasis. They have also been associated with micronutrient deficiencies, postmenopausal fracture, kidney disease, pneumonia, and intestinal infection. For long-term use in patients with esophagitis, PPIs should be titrated to the lowest symptomatically effective dose.

H2-receptor antagonists, including cimetidine, famotidine, and nizatidine, reversibly block histamine's action on H2-receptors of gastric parietal cells, which in turn inhibits acid production. They heal most mild esophagitis and are appropriate for continued maintenance therapy. However, tolerance can develop and may reduce their efficacy over time. (Ranitidine, another H2-blocker, was withdrawn from the market in April 2020 due to contamination with N-nitrosodimethylamine.)

Prokinetic agents, such as metoclopramide, may be helpful in patients with mild symptoms, but they are typically prescribed in tandem with acid suppressants. Long-term use can be hazardous.

Antacids reduce the acidity of reflux but not its frequency. These drugs, which include aluminum hydroxide and magnesium hydroxide, are typically taken by patents for mild GERD symptoms after meals and at bedtime. Depending on the antacid chosen, they may also afford relief for constipation or loose stools.

Learn more about the medical management of GERD.

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