TRC: Proton pump inhibitors for reflux

Proton pump inhibitors

Proton pump inhibitors for reflux

Acid inhibitory therapy is effective in healing reflux-oesophagitis and treating symptoms of reflux disease. With the powerful acid inhibition induced by PPIs (see proton pump inhibitors for ulcers), over 95% of patients with reflux disease are cured after 12 weeks therapy. However, within one year after stopping therapy, over 75% of patients who had grade 2 endoscopic oesophagitis or higher will relapse.

Therefore, maintenance therapy with PPIs or H2 receptor antagonists is indicated in those patients. In case of severe reflux symptoms, the amount of reflux should be evaluated by 24-hour pH monitoring or on the basis of mucosal inflammation observed during endoscopy.

Which effect is NOT related to PPI therapy?

Extra info: Due to lower gastric acid and increased pH after PPI therapy, there is an increase in gastrin secretion (as part of a feedback loop) and an increase in local bacteria. The PPIs are also potent inhibitors on the cP450 system.

Option explanation:

serum gastrin increases

increase in small bowel bacterial growth

cytochrome P450 interactions

gallstone formation

Maintenance therapy with PPIs should be considered in patients with

Extra info: The severity of all three of the diseases warrants maintenance therapy with a PPI.

Option explanation:

Barrett oesophagus

oesophageal ulceration (endoscopy)

grade 3 oesophagitis

all three diseases