Abstract
Proton pump inhibitor (PPI) is the first-line drug for GERD and is far more effective than H2-receptor antagonist (H2RA). H2RA suppresses mainly nocturnal gastric acid secretion from parietal cells, while PPI blocks acid production at nighttime as well as daytime when acid refluxes often occur. PPI-test is a therapeutic diagnosis and can reliably distinguish GERD from other diseases presenting similar symptoms. Initial therapy of GERD should be started with a full dose of PPI. However, most of the GERD patients need maintenance therapy. The maintenance dose of PPI should be individualized with a titration technique ('New Step-down therapy'). A small number of GERD patients resistant to PPI therapy may be due to nocturnal acid breakthrough (NAB) or rapid metabolism of PPI (extensive metabolizer for CYP2C19).
MeSH terms
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2-Pyridinylmethylsulfinylbenzimidazoles
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Antacids
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Aryl Hydrocarbon Hydroxylases / physiology
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Benzimidazoles
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Circadian Rhythm
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Cytochrome P-450 CYP2C19
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Depression, Chemical
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Drug Resistance
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Enzyme Inhibitors / administration & dosage*
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Enzyme Inhibitors / metabolism
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Enzyme Inhibitors / pharmacology
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Gastric Acid / metabolism
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Gastroesophageal Reflux / drug therapy*
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Histamine H2 Antagonists / pharmacology
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Histamine H2 Antagonists / therapeutic use
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Humans
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Lansoprazole
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Mixed Function Oxygenases / physiology
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Omeprazole / analogs & derivatives*
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Proton Pump Inhibitors*
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Rabeprazole
Substances
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2-Pyridinylmethylsulfinylbenzimidazoles
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Antacids
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Benzimidazoles
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Enzyme Inhibitors
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Histamine H2 Antagonists
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Proton Pump Inhibitors
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Lansoprazole
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Rabeprazole
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Mixed Function Oxygenases
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Aryl Hydrocarbon Hydroxylases
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CYP2C19 protein, human
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Cytochrome P-450 CYP2C19
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Omeprazole