H2 blockers and proton pump inhibitors (PPIs) are used to suppress acid in patients with GERD. H2 blockers are less expensive than PPIs and probably underutilized, he noted. H2 blockers may be safer than PPIs over the long term because PPIs interfere with calcium absorption. PPIs are expensive and probably overutilized, but these drugs are highly effective. PPIs should be given along with calcium supplementation to prevent hip fracture. Neither H2 blockers nor PPIs are helpful in non-acidic reflux, he commented.
Explore this issue:February 2008
Nissen fundoplication is the most effective treatment to prevent both acid and non-acidic reflux, but this is expensive and invasive, Dr. Toohill said. Nissen fundoplication can be done laparoscopically. Dr. Toohill cautioned that the procedure should be done by experienced surgeons, because there is a learning curve and complications can occur.
The Gaviscon Advance Raft is a new drug with a great deal of promise for non-acidic reflux, he said. This preparation is partly derived from seaweed and it forms an alginate raft that prevents gastric contents from backflowing. The oral drug is widely used in Europe but is not yet available in the United States. The side-effect profile is favorable and better than that with the Gaviscon liquid, he said.
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