Initial empiric management of adults with reflux-like symptoms

This algorithm shows the initial empiric management of adults with reflux-like symptoms. Most patients with typical reflux-like symptoms of heartburn or regurgitation are candidates for empiric treatment. Refer to UpToDate content on the initial management of GERD in adults for details on lifestyle changes and medication selection and management.

GERD: gastroesophageal reflux disease; H2RA: histamine 2 receptor antagonist; PPI: proton pump inhibitor.

* Identify symptom triggers (eg, nocturnal symptoms, large meals, alcohol, soda intake, tobacco use, or specific foods), and individualize lifestyle changes to address them.

¶ Low-dose H2RA options include twice-daily cimetidine 200 mg, famotidine 10 mg, and nizatidine 75 mg. Standard-dose H2RA options include twice-daily cimetidine 400 mg, famotidine 20 mg, and nizatidine 150 mg.

Δ Standard-dose PPI options include once-daily dexlansoprazole 30 mg, esomeprazole 40 mg, lansoprazole 30 mg, omeprazole 20 mg, pantoprazole 40 mg, or rabeprazole 20 mg.

◊ If patient had no response to intermittent H2RA therapy, start PPI rather than twice-daily H2RA. Refer to UpToDate content for details.

§ Approximately two-thirds of adults with GERD will have recurrent symptoms. Patients whose symptoms recur <3 months after discontinuing PPI or vonoprazan may require maintenance acid suppression. Patients without recurrent symptoms should continue lifestyle and dietary modifications.

¥ Tapering is not required for short (eg, <6 months) duration of treatment. Refer to UpToDate content for details regarding tapering and discontinuing PPI or vonoprazan.

‡ Professional guidelines provide different criteria for screening for Barrett's esophagus and are based predominantly on expert consensus.

Graphic 145885 Version 4.0

خرید پکیج

Initial empiric management of adults with reflux-like symptoms