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 |