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Proton Pump Inhibitors

Life before PPIs. The history of dyspepsiaSurgery and dietVagotomy/PyloroplastySteamed fish and milk puddingsH2-receptor antagonistsTagamet

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Proton Pump Inhibitors

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    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? ERADICATE NSAID-related? 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 45-55 DEBATABLE

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