Proton Pump Inhibitors

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Presentation transcript:

Proton Pump Inhibitors Appropriate Use in General Practice

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

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

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

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

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

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

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

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