ASGE Masterclass: Barrett’s Esophagus, GERD and Esophageal Adenocarcinoma (Virtual)

Best and worst of PPIs

Pdf Summary

This document discusses various aspects of proton pump inhibitors (PPIs) in the medical management of gastroesophageal reflux disease (GERD). PPIs are medications that block the final step of acid secretion and are effective in controlling esophagitis healing. However, they may not be as effective for more severe cases of GERD. The document also emphasizes the importance of dosing timing, highlighting that taking PPIs before breakfast and dinner is more effective in controlling intragastric pH levels than taking them before breakfast alone. Additionally, PPIs do not reduce reflux episodes and regurgitation as well as surgery. Safety concerns regarding PPIs include potential interactions with other medications, decreased efficacy with clopidogrel, and confounding factors in studies on their use. However, the overall safety profile of PPIs is considered good. Lifestyle modifications, such as weight loss and sleep position changes, are recommended as part of GERD management. Adjunctive therapies like baclofen and prokinetics may also be beneficial. The document mentions potassium channel acid blockers as an alternative to PPIs and discusses the results of a study comparing vonoprazan and lansoprazole in patients with erosive esophagitis. It concludes by stating that while PPIs are safe and improve quality of life, treatment for GERD should be individualized and non-medical interventions or surgery may be considerations for certain patients.

Keywords

proton pump inhibitors

GERD

acid secretion

esophagitis healing

dosing timing

reflux episodes

safety concerns

lifestyle modifications

alternative to PPIs

individualized treatment