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Proton Pump Inhibitors

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Presentation on theme: "Proton Pump Inhibitors"— Presentation transcript:

1 Proton Pump Inhibitors
Appropriate Use in General Practice

2 Life before PPIs The history of dyspepsia Surgery and diet
Vagotomy/Pyloroplasty Steamed fish and milk puddings H2-receptor antagonists Tagamet & SKF Zantac & Glaxo

3 Proton Pump Inhibitors
Losec (Omeprazole)(Astra) Zoton (Lansoprazole)(Wyeth) Pariet (Rabeprazole)(Janssen) Nexium (Esomeprazole)(Astra)

4 NICE Guidance Issued in 2000
Targeted use to make best use of resources

5 Dyspeptic Symptoms Diagnosed or not? Non-ulcer Dyspepsia
Peptic Ulceration GORD

6 Peptic Ulceration Helicobacter-related? NSAID-related? ERADICATE
Co-Prescribe PPI if cannot stop NSAID

7 Gastro-Oesophageal Reflux
Severe healing dose PPI until symptoms controlled maintenance dose to prevent recurrence Complicated stricture, ulcer, haemorrhage etc full dose maintained Mild alternative Rx: antacid, alginate, H2RA

8 Non-ulcer Dyspepsia Use Acid Suppressor (H2RA) NOT PPI
Step-up or Step-down

9 Investigation Over 55 ENDOSCOPY Alarm Symptoms ENDOSCOPY
dysphagia anaemia progressive weight loss Under 45 NO INVESTIGATION DEBATABLE

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