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Empiric PPI therapy or endoscopy for the initial management of patients with GERD in the absence of alarm features?

  • Practice Point
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From Nature Clinical Practice Gastroenterology & Hepatology

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Abstract

Most clinicians prescribe an empiric PPI trial for patients presenting with typical GERD symptoms in the absence of alarm features, but there are limited data available from randomized trials to support this approach. In this Practice Point commentary I discuss the findings and limitations of a randomized study conducted by Giannini and colleagues that evaluated the use of empiric therapy with esomeprazole versus endoscopy-oriented therapy for the initial management of patients with typical symptoms of GERD without alarm features. The results suggest that an empiric PPI trial has similar efficacy to, and is more cost-effective than, endoscopy-oriented therapy. However, I caution that the application of these results might not extend to patients with atypical presentations of GERD, and highlight the possibility that other diagnostic tools such as reflux monitoring or new endoscopic modalities might yield superior results to both empiric and endoscopy-oriented therapies in this setting.

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References

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Author notes

  1. Division of Gastroenterology and Hepatology, Medical University of South Carolina, 25 Courtenay Avenue, ART 7100A, MSC 290, Charleston, SC 29425, USA velaaqui@musc.edu

Authors and Affiliations

  1. MF Vela is Assistant Professor of Medicine in the Division of Gastroenterology and Hepatology at the Medical University of South Carolina, Charleston, SC, USA.,

    Marcelo F Vela

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  1. Marcelo F Vela
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Competing interests

M Vela is on the Speaker's Bureau for AstraZeneca and is a Consultant for Medtronic.

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Vela, M. Empiric PPI therapy or endoscopy for the initial management of patients with GERD in the absence of alarm features?. Nat Rev Gastroenterol Hepatol 5, 548–549 (2008). https://doi.org/10.1038/ncpgasthep1228

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  • DOI: https://doi.org/10.1038/ncpgasthep1228

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