Curbside Consultation in GERD: 49 Clinical Questions

Philip O. Katz, MD

Question 14: What Are The Choices For Therapeutic Trials (Doses And Length Of Trial) In Patients With Reflux Symptoms? Does This Mean That You Stop Ppis If They Are Not Effective? (continued)

The choices for therapeutic trials are myriad, debated, and unfortunately not systematically studied to my satisfaction. As true diagnostic tests, therapeutic trials have fallen short of their expected promise and whereas easy and expedient compared to diagnostic testing have limits and should not be indefinite as often is the case in practice. I have found several clinical observations to be helpful in planning therapeutic trials. Immediate relief of symptoms (day 1, 2, or 3) is extremely unusual when encountering a new patient. Changing proton pump inhibitors is rarely effective on an…