Curbside Consultation in GERD: 49 Clinical Questions

Philip O. Katz, MD

Question 23: A Patient With Classic Gerd Symptoms Is Unhappy With His Current Treatment. What Is The Approach To A Patient With Continued Symptoms On Once-Daily Ppi? On Twice-Daily Ppi? (continued)

A 65-year-old gentleman with classic GERD (heartburn and regurgitation) presents with incomplete symptom relief on once-daily proton pump inhibitors (PPIs). He has endoscopic findings of erosive esophagitis and Barrett’s (biopsy confirmed). Once-daily PPI improves his symptoms by about 65%, and whereas an increase in PPI dose results in complete daytime symptom relief, some residual nighttime symptoms remain. The approach to the patient at this point is not straightforward. We have come to “expect” that the vast majority of patients who present with heart-burn will have…