Reducing Acid Reflux With Diet However, reflux can become much worse while you are sleeping or ... This means that the position of your body can have a large influence on ...Sour Balls Acid Reflux
Kenneth R. DeVault, MD, FACGDisclosures
May 16, 2003
It is clear that PPI therapy results in the best symptom control and esophagitis healing among our available medical options. Once healing is achieved, healing is also best maintained with chronic PPI therapy. It is also clear that some patients will do well on the less-intense acid suppression resulting from H2RA therapy. What is much less clear is whether to start treatment with an H2RA and then use a PPI for failures (step-up therapy), start all patients on a PPI and then try to switch them to an H2RA (step-down therapy), or perhaps initiate and leave them on a PPI. These strategies have not been well tested in randomized trials, but have been examined in many modeling analyses. For example, step-up therapy was compared against starting with a high-dose PPI trial and then stepping down. The step-down approach resulted in improved symptom relief and quality of life over 1 year with the use of less diagnostic tests, although this strategy actually resulted in a small increase in total costs. A very practical study in a Veterans Administration population demonstrated that patients who were "" frequently could be stepped down. The researchers attempted to step down 71 patients and found that 42% could not be stepped down; 42% could be stepped down to H2RAs, prokinetics, or a combination; and 15% could be stepped all the way off of medication. A recent, double-blind, multicenter trial randomized patients to continuous H2RA therapy, continuous PPI therapy, step-up from an H2RA to PPI, or step-down from a PPI to an H2RA. Continuous PPI therapy resulted in patients being free of heartburn on 81.4% of days, step-down on 73.6%, step-up on 66.6%, and continuous H2RA on 66.3% of days. Modeling studies that use cost as an important end point are highly dependent on the assumptions used in constructing the model. For example, a study using the costs from a Veterans Administration formulary found step-up to be considerably cheaper than other strategies.
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Cite this: Should GERD Therapy Be Stepped Up, Stepped Down, or Not Stepped at All? - Medscape - May 19, 2003.
Kenneth R. DeVault, MD, FACG, Associate Professor; Associate Chair for Research, Department of for 1 last update 12 Jul 2020 Medicine; Director of Research, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida Kenneth R. DeVault, MD, FACG, Associate Professor; Associate Chair for Research, Department of Medicine; Director of Research, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
Reducing Acid Reflux With Diet Causes (🔥 Treatment) | Reducing Acid Reflux With Diet 10 Foodshow to Reducing Acid Reflux With Diet for Dr. DeVault has disclosed that he has received grants for clinical research from AstraZeneca, Wyeth Ayerst, Janssen, and Novartis. He has also disclosed that he has served as an advisor or consultant for AstraZeneca.
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