Slocum-Dickson Medical Group Clinical Guideline
 

Refer To Gastroesophageal Specialist:
If patient has dysphagia, GI bleeding (occult or active),
unexplained weight loss, anemia or history gastric surgery.

STEP 1 - Incorporate Lifestyle Changes

  1. Lose Weight
  2. Stop Smoking
  3. Decrease Alcohol Intake
  4. Elevate Head of Bed
  5. Do Not Eat 2-3 Hours Before Bedtime
  6. Avoid Caffeine, Chocolate, Mints and Fatty Foods
  7. Avoid Meds That Complicate GERD/Gastritis: CCB's, Theophylline, ASA, NSAID's Beta2-Agonists

NO RELIEF - Proceed To Next Step

STEP 2 - Recommend OTC Products

  1. Antacids
  2. H2 Antagonist: Axid AR, Pepcid AC, Zantac 75

NO RELIEF - Proceed To Next Step

STEP 3 - Recommend 1st Line Prescription Agent

  1. H2 Antagonist:
    Ranitidine 150 - 300mg BID
    Use H2 Blocker for 6 - 8 weeks, Then D/C

    If "Classic" GERD Symptons Recur
    Continue H2 Blocker QHS - BID or Refer to
    Gastroenterology to Consider EGD

NO RELIEF - Proceed To Next Step

STEP 4 - Proton Pump Inhibitors

  1. Prevacid 30 mg QD or Prilosec 20 mg QD or Aciphex 20 mg QD
  2. For PTS Taking Prevacid 30 mg QD or Prilosec 20 mg QD Chronically
    If SX Relief Inadequate, Switch To Alternate Product At Same Dose
    If SX Relief Still Inadequate Proceed To STEP 5
  3. Additional Considerations:
    A) Once SX Controlled For 8 - 12 Weeks Attempt To Change SID To QOD Dosing Or Decrease QD Dosing
    B) Pts. > 50 Y/O Who Have Had GERD Or Pt. < 50 Who Have Refractory Symptons Requiring Chronic PPI Therapy SX Have Never Been Endoscoped Should Be Referred To
    Gastroenterology For EGD.

NO RELIEF - Proceed To Next Step

STEP 5 - GI Referral

  1. Gastroenterology Referral -----> Consider Further Investigation