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Table 3 Current indications of proton pump inhibitor (PPI) therapy

From: Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Clinical setting

PPI dose and duration

GERD

 

 Erosive Esophagitis (A/B)

Standard dose PPI therapy for 8-12 weeks

 Erosive Esophagitis (C/D)

Double dose PPI therapy for 8-12 weeks

 NERD

Standard dose PPI therapy for 4-8 weeks

 Long-term Management (both GERD and NERD)

Standard (or half) dose PPI maintenance (continuous, intermittent or on-demand, depending on clinical characteristics of the patient)

 Barrett’s Esophagus

Long-term individually-tailored PPI therapy

 Extra-digestive GERD

Standard or double-dose PPI therapy for at least 12 weeks

Eosinophilic Esophagitis

Standard or double dose PPI therapy for 8-12 weeks

H. pylori Eradication

Double dose, twice daily, PPI therapy for 7-14 days (in combination with antimicrobials)

Non H. pylori-related PU disease

Standard dose PPI therapy for 4-8 weeks

Zollinger-Ellison Syndrome

High-dose (eventually twice daily) long-term PPI therapy

Stress Ulcer Prophylaxis

in patients with risk factors

Standard PPI therapy by intravenous route only during ICU stay

Dyspepsia

 

 Uninvestigated Dyspepsia in Patients younger  than 45 yrs

Standard or half-dose empiric PPI therapy for 4 weeks

 Functional Dyspepsia (EPS phenotype)

Standard or half dose PPI therapy for 4-8 weeks

NSAID-gastropathy

 

 Prevention of gastro-duodenal lesions and  events

Standard or half-dose PPI therapy, starting form the very first dose of NSAID in patients at GI risk

Treatment of gastro-duodenal lesions

Standard dose PPI therapy for 8 weeks

Steroid therapy

No need for gastroprotection unless used in combination with NSAIDs

Anti-Platelet Therapy

Standard dose PPI therapy, starting form the very first dose of antiplatelet agent in patients at GI risk

Anti-Coagulant Therapy

No need for gastroprotection unless used in combination with antiplatelet therapy

PU Bleeding

Intravenous bolus of 80 mg of the available injectable PPIs, followed by 8 mg/h for 72 hours

Cirrhosis

 

 Hypertensive gastropathy

No need for acid suppression

 Prevention or/and treatment of esophageal ulcers  after sclerotherapy or variceal band ligation

Standard dose PPI therapy for 10 days (longer treatment should be avoided taking into account the risk of spontaneous bacterial peritonitis)

Pancreatic Diseases

 

 Acute pancreatitis

No benefits from acid suppression

 Chronic pancreatitis

Standard PPI therapy only in patients with steatorrhea, refractory to enzyme replacement therapy