In 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.
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)
- B to E/0
Level of evidence III
Classification of recommendation C