Therapeutic target
Inhibition of excess acid to prevent progression of mucosal changes.
Therapy recommendations
- 1. nutritional recommendations (see below “Further therapy“).
- 2. antacids (e.g., magaldrate, hydrotalcid).
- 3. proton pump inhibitors (PPI; acid blockers): when gastroesophageal reflux disease (GERD) is suspected and no alarm symptoms are present: such as. Dysphagia (difficulty swallowing), odynophagia (pain on swallowing), recurrent (“recurring”) vomiting, (involuntary) weight loss, anemia (anemia), evidence of gastrointestinal blood loss (gastrointestinal bleeding) or a mass):
- Long-term therapy often needed due to high recurrence rates (recurrence of disease).
- Maintenance dosing (step down) according to symptoms in more severe courses of GERD.
- On demand therapy (on demand) in milder courses of GERD with a dose every 2-3 days.
- In the absence of therapeutic success doubling or tripling of the dose possible
- See also under “Further therapy”.
Notice.
- Patients with endoscopically negative reflux disease (NERD; English : Non erosive reflux disease), i.e. symptomatic reflux without endoscopic and histological evidence of reflux esophagitis, naturally respond worse to PPI therapy than patients with evident reflux esophagitis.Patients with NERD should initially be treated with PPI at half the standard dose. If treatment is not successful after 4 weeks, the dose should be gradually increased to twice the standard dose. If necessary, also prescription of lower potent drugs such as H2-receptor antagonists or antacids (drugs to neutralize gastric acid).
- In hypersensitive esophagus and functional heartburn, tricyclic antidepressants and serotonin reuptake inhibitors have been shown to be effective.
Indications (areas of application) of proton pump inhibitors (PPI).
- Gastropathy (stomach disease) caused by NSAIDs (nonsteroidal anti-inflammatory drugs).
- Helicobacter pylori eradication/complete elimination of the pathogen (for more information, see gastritis (gastritis)/medicinal therapy).
- Reflux esophagitis (esophagitis due to reflux (reflux) of clean gastric juice).
- Ulcus duodeni (duodenal ulcer)
- Ulcus ventriculi (gastric ulcer)
Dosage instructions depending on the severity of esophagitis (esophagitis):
- A/B (mild esophagitis): PPI in standard dose for 4 weeks, then as-needed/intermittent.
- C/D (severe esophagitis: PPI in standard dose for 8 weeks, then tried dose reduction.
Further notes
- If necessary, additional intake of an alginate suspension – in case of insufficient response of reflux symptoms to proton pump inhibitors (PPI) for symptom improvement (eg, increase in symptom-free nights).
Reflux in pregnancy (escalation stages).
- Antacids (eg, magaldrate, hydrotalcid).
- H2 antihistamines (preferably ranitidine).
- Proton pump inhibitors (PPI): omeprazole.
Supplements (dietary supplements; vital substances)
In addition to the above-mentioned medicinal measures, it is important to note the importance of a balanced acid-base balance (see also under nutritional medicine – acid-base balance); if necessary, taking an alkaline dietary supplement.
Suitable dietary supplements should contain the following vital substances:
- Vitamins (vitamin D 3)
- Minerals (calcium citrate, magnesium citrate, potassium citrate).
- Trace elements (zinc)
Note: The listed vital substances are not a substitute for drug therapy. Food supplements are intended to supplement the general diet in the particular life situation.Comparison chart: proton pump inhibitors
| Drug | Equivalent dose (mg) | Dosage forms | Recommended dosages | Maximum daily dose(mg) | |
| Low dose | Medium dose | ||||
| Dexlansoprazole | 602 | HVW | 1 x 30 | 1 x 60 | 60 |
| Esomeprazole | 20 | HMK, KMR, PMR, GMR3 | 1 -2 x 103 | 1 – 2 x 20 | 40 (1604) |
| Lansoprazole | 30 | HKM, KMR | 1 -2 x 15 | 1 – 2 x 30 | 60 (1804) |
| Omeprazole | 20 | HMK, KMR, TMR | 1 – 2 x 10 | 1 – 2 x 20 | 40 (1204) |
| Pantoprazole | 40 | TMR | 1 – 2 x 20 | 1 – 2 x 40 | 80 (1604) |
| Rabeprazole | 20 | TMR | 1 – 2 x 10 | 1 – 2 x 20 | 40 (1204) |
Comparison table of PPI (p.o.) dosing (adults).
Legend1Abbreviation: enteric-coated granules (GMR), enteric-coated hard capsules (HKM), modified-release hard capsules (HVW), enteric-coated capsules (KMR), enteric-coated tablets (TMR)2Equivalent dose 60 mg (as per pharmaceutical manufacturer’s pivotal studies)310 mg available as granules for solution preparation only (for children)4 For therapy of Zollinger-Ellison syndrome.
