Drugs In Practice

Drugs for GERD and Peptic Ulcer Disease with its activation. Whether concurrent use of clopidogrel and a PPI results in clinically significant adverse cardiovascular outcomes is not clear.15,16 Since omeprazole and esomeprazole appear to be most likely to reduce the antiplatelet activity of clopidogrel and the FDA specifically warns against their concomitant use, it would be prudent to choose another PPI in patients taking clopidogrel.17

Pregnancy

PPIs are generally considered safe for use during pregnancy, but clinical data are limited. In a metaanalysis of 7 observational studies, first trimester PPI use (predominantly omeprazole) was not associated with an increased risk of congenital malformations.18 A cohort study produced similar findings.19

Alginate

A polysaccharide derived from brown algae, alginate forms a floating foam/gel that acts as a physical barrier between gastric contents and the lower esophagus. In one randomized, placebocontrolled trial, addition of an alginate-based product improved symptoms in patients who had heartburn or regurgitation despite standard-dose PPI treatment.20 Alginatebased products contain aluminum hydroxide and magnesium carbonate. Alginate-based and other products available in many countries contain larger amounts of alginate.

Antireflux Surgery

In patients with PPIrefractory and reflux-related chronic heartburn, antireflux surgery is an effective alternative to long-term pharmacologic treatment.21

Peptic Ulcer Disease

Peptic ulcer disease (PUD) is most commonly caused by Helicobacter pylori infection. Use of nonsteroidal antiinflammatory drugs (NSAIDs), including aspirin, is another common cause. Eradication of H. pylori can promote ulcer healing and prevent recurrence of gastric and duodenal ulcers.22 It may also reduce the risk of gastric cancer in those who have a family history of the disease.23

PPI Treatment

All patients with PUD should be treated with a PPI for ulcer healing. If the underlying cause of PUD is identified and addressed (stopping the NSAID or eradicating H. pylori), long-term PPI treatment may not be needed. Long-term PPI treatment is recommended for patients with NSAIDinduced PUD who are unable to stop taking NSAIDs (fixed-dose NSAID/PPI combinations are available for such patients) and for those whose PUD is not caused by H. pylori or NSAIDs.12

DIAGNOSIS OF H. pylori

Many diagnostic tests are available to identify H. pylori infection.24, 25