Curbside Consultation of the Pancreas: 49 Clinical Questions

Scott Tenner, MD, MPH; Alphonso Brown, MD, MS Clin Epi; Frank Gress, MD

Question 36: My Patient Has Reflux Esophagitis In Spite Of Daily Omeprazole. His Serum Gastrin On Omeprazole Is 750. What Is The Next Step In Evaluation For Gastrinoma? (continued)

Susan Truong, HMS III; Alphonso Brown, MD, MS Clin Epi

Reflux esophagitis is best treated with anti-secretory therapy, proton pump inhibitors (PPIs). The step-up approach for heartburn, reflux esophagitis, beginning with over-the-counter antacids, progressing to H2 blockers, and then PPIs, has been replaced with a step-down approach. As the cost of PPIs, with the advent of generic omeprazole, has decreased, this approach is not effective and not cost effective. PPIs are considered just as safe as H2 blockers, yet they are far more effective. Years prior, when PPIs were first introduced as omeprazole (Prilosec [AstraZeneca, Wilmington, DE), safety…
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