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The latest educational program from NPS MedicineWise- Starting, stepping down and stopping medicines-aims to equip people with evidence-based information about managing GORD, including resources to help support discussions with health professionals about safely and effectively reducing and stopping PPI treatment when appropriate. “In addition to talking to your doctor about whether you can reduce or stop taking PPIs, it can also be helpful to discuss possible lifestyle changes, such as losing weight, stopping smoking or reducing alcohol consumption, which could reduce symptoms or stop the need for future PPI treatment.” “But it is really important you have a conversation with your doctor before stopping treatment to ensure this is done safely and effectively. Up to 6 out of 10 people can also step down and stop taking PPIs without their symptoms returning. “After completing an initial course of daily PPI treatment, which is usually around four to eight weeks, many people can reduce and step down the amount of medicine they take and still maintain control of their symptoms. However, long-term regular PPI therapy is generally not necessary nor recommended for most people with GORD.
“As PPIs are prescribed frequently and are effective at reducing symptoms, some people may consider them as lifetime medicines. You may also have a burning chest pain or discomfort after eating, which can be a symptom of heartburn. At a single dose, baclofen can decrease the number of TLOSRs and reflux episodes in both healthy subjects 15 and GORD patients.
People experiencing reflux may feel stomach acid coming up into their mouth, causing a sour, unpleasant taste. NPS MedicineWise is encouraging people who take PPIs to have conversations with their doctor about whether stepping down (ie reducing) or stopping this treatment is appropriate for them.ĭr Jill Thistlethwaite, Medical Advisor, NPS MedicineWise, says, “GORD is diagnosed based on symptoms of reflux or heartburn that are occurring two or more times per week, or having a severe and significant impact on your life. PPIs are among the most commonly prescribed medicines in general practice in Australia for treating symptoms of GORD. Heartburn-which can be a symptom of GORD-is experienced by around one in five adults at least once each week. Common brand names include Losec, Nexium, and Somac. Newer endoscopic modalities, including the Stretta and endocinch procedures, are less invasive and have fewer complications than antireflux surgery, but response rates are lower.Many Australians use proton pump inhibitors (PPIs)-such as omeprazole, esomeprazole and pantoprazole-to manage symptoms of gastro-oesophageal reflux disease (GORD), often for extended periods of time. They allow rapid resolution of symptoms and healing of the esophagus in 80-90 of patients. Antireflux surgery, including open and laparoscopic versions of Nissen fundoplication, is an alternative treatment in patients who have chronic reflux with recalcitrant symptoms. Proton pump inhibitors (PPIs) limit acid secretion in the stomach. Diagnostic testing should be reserved for patients who exhibit warning signs (i.e., weight loss, dysphagia, gastrointestinal bleeding) and patients who are at risk for complications of esophagitis (i.e., esophageal stricture formation, Barrett's esophagus, adenocarcinoma). In patients with erosive esophagitis identified on endoscopy, a PPI is the initial treatment of choice. The preferred empiric approach is step-up therapy (treat initially with an H2RA for eight weeks if symptoms do not improve, change to a PPI) or step-down therapy (treat initially with a PPI then titrate to the lowest effective medication type and dosage).
In patients with reflux esophagitis, treatment is directed at acid suppression through the use of lifestyle modifications (e.g., elevating the head of the bed, modifying the size and composition of meals) and pharmacologic agents (a histamine H 2-receptor antagonist taken on demand or a proton pump inhibitor taken 30 to 60 minutes before the first meal of the day). The primary treatment goals in patients with gastroesophageal reflux disease are relief of symptoms, prevention of symptom relapse, healing of erosive esophagitis, and prevention of complications of esophagitis.
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