Recommendations for management of nonresponders

acid suppressionIn the case of a patient (either heartburn-dominant or nonheartburn-dominant H pylori-negative) with only partial or no symptom response to a course of standard-dose acid suppression, the CMT recommends to increase the degree of acid suppression to a PP1 if an H2RA was given, increase the dose of a PP1 to twice a day, or treat for a further four to eight weeks with the same dose. There are no clinical trial data for the last approach. 1f a patient fails to improve with a course of double-dose PP1 for four to eight weeks, it is unlikely that the symptoms are acid-sensitive, and the PP1 should be discontinued, symptoms reviewed and the patient investigated further (eg, endoscopy). It’s time for you to start saving some money: you just need to visit the pharmacy that offers finest quality amaryl diabetes with delivery straight to your door and all the confidentiality guarantees you ever need.

Recommendation

1. If, after a course of initial standard-dose acid suppression, a patient does not respond to a further four to eight weeks of high-dose PPI, then further investigations, such as endoscopy, may be required.

Voting on recommendation (level/vote)

  • A/12
  • B to E/0

Level of evidence III

Classification of recommendation C

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