Erosive esophagitis and h pylori: acid reflux inside an outline of the esophagus and the stomach

Take the acid test.

Consider these
questions carefully, because your
answers may reveal the need to further optimize your
treatment approach.

Answer these questions about
H. pylori treatment

1

Are any of your patients failing on their current H. pylori regimen?

Yes
Not Sure
No

You’re not alone. 1 out of 5 patients fails H. pylori therapy.1,2

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Test your patients before and after treatment, because 1 out of 5 patients fails H. pylori therapy.

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That is fortunate, but you may want to test your patients before and after treatment, because 1 out of 5 patients fails H. pylori therapy.

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2

Are you concerned that inadequate acid suppression may be contributing to treatment failure?

Very
Concerned
Somewhat
Concerned
Not
Concerned

Your concern is valid, because growth-dependent antibiotics work best against actively dividing H. pylori bacteria when gastric pH is from 6 to 8.3

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You’re on to something, because growth-dependent antibiotics work best against actively dividing H. pylori bacteria when gastric pH is from 6 to 8.3

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It may be worth taking a closer look, because growth-dependent antibiotics work best against actively dividing H. pylori bacteria when gastric pH is from 6 to 8.3

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3

Are complicated dosing schedules making adherence difficult for some of your patients?

Yes
Maybe
No

Treatment often includes a large number of pills with confusing dosing instructions. Further, the need to take most PPIs 30-60 minutes before a meal can present challenges for patients.4-6

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It’s something to be aware of. Treatment often includes a large number of pills with confusing dosing instructions. Further, the need to take most PPIs 30-60 minutes before a meal can present challenges for patients.4-6

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Consider asking them. Treatment often includes a large number of pills with confusing dosing instructions. Further, the need to take most PPIs 30-60 minutes before a meal can present challenges for patients.4-6

Learn More

Answer these questions about
erosive esophagitis treatment

1

Do you have any patients with recurring erosive esophagitis?

Yes
Not Sure
No

You’re not alone. Recurrences occur in ~71-80% of patients within 6 months of PPI discontinuation.7-10

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Consider testing regularly, because recurrences occur in ~71-80% within 6 months of PPI discontinuation.7-10

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Consider testing before and after treatment, because recurrences occur in ~71-80% of patients within 6 months of PPI discontinuation.7-10

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2

Is erosive esophagitis causing complications for your patients?

Yes
Maybe
No

You’re likely aware that complications can include respiratory problems, chest pain, and even esophageal cancer.6,11,12

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It’s important to know, because complications can include respiratory problems, chest pain, and even esophageal cancer.6,11,12

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You may want to probe deeper. Complications can include respiratory problems, chest pain, and even esophageal cancer.6,11,12

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3

Could treatment challenges be getting in the way of complete healing for patients?

Definitely
Possibly
Doubtful

It’s not uncommon. Most PPIs require dosing 30-60 minutes before a meal, which can present challenges for patients.

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It’s something to be aware of. Most PPIs require dosing 30-60 minutes before a meal, which can present challenges for patients.

Learn More

Consider asking them. Most PPIs require dosing 30-60 minutes before a meal, which can present challenges for patients.

Learn More

References:

  • 1.Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017;112(2):21‍2‍-‍23‍9. doi:10.103‍8/ajg.20‍16.56‍3
  • 2.Alsamman MA, Vecchio EC, Shawwa K, Acosta-Gonzales G, Resnick MB, Moss SF. Retrospective analysis confirms tetracycline quadruple as best Helicobacter pylori regimen in the USA. Dig Dis Sci. 20‍19;64‍(10):28‍93‍-‍28‍98. doi:10.1007/s10620-019-05694-4
  • 3.Shah SC, Iyer PG, Moss SF. AGA clinical practice update on the management of refractory Helicobacter pylori Infection: expert review. Gastroenterology. 20‍21;1‍60‍(5):18‍31-18‍41. doi:10.1053/ j.gastro.20‍20.11‍.0‍59
  • 4.Solem C, Mody R, Stephens J, Macahilig C, Gao X. Mealtime-related dosing directions for proton-pump inhibitors in gastroesophageal reflux disease: physician knowledge, patient adherence. J Am Pharm Assoc (2003). 20‍14;54(2):14‍4-1‍53. doi:10.1331/JAPhA.20‍14‍.131‍17
  • 5.Mermelstein J, Mermelstein AC, Chait MM. Proton pump inhibitors for the treatment of patients with erosive esophagitis and gastroesophageal reflux disease: current evidence and safety of dexlansoprazole. Clin Exp Gastroenterol. 20‍16;9:163-1‍72. doi:10.2147/CEG.S9‍16‍02
  • 6.Dickman R, Maradey-Romero C, Gingold-Belfer R, Fass R. Unmet needs in the treatment of gastroesophageal reflux disease. J Neurogastroenterol Motil. 20‍15;21(3):30‍9-3‍19. doi:10.50‍56/jnm151‍05
  • 7.Katzka DA, Kahrilas PJ. Advances in the diagnosis and management of gastroesophageal reflux disease. BMJ. 20‍20;3‍71:m37‍86. doi:10.11‍36/bmj.m378‍6
  • 8.Hetzel DJ, Dent J, Reed WD, et al. Healing and relapse of severe peptic esophagitis after treatment with omeprazole. Gastroenterology. 19‍88;95(4):90‍3-91‍2. doi:10.10‍16/00‍16-50‍85(88)90‍162-x
  • 9.Metz DC, Howden CW, Perez MC, Larsen L, O’Neil J, Atkinson SN. Clinical trial: dexlansoprazole MR, a proton pump inhibitor with dual delayed-release technology, effectively controls symptoms and prevents relapse in patients with healed erosive oesophagitis. Aliment Pharmacol Ther. 20‍09;29(7):74‍2‍-‍754. doi:10.1111/j.13‍65-20‍36.20‍09.039‍54.x
  • 10.Vakil NB, Shaker R, Johnson DA, et al. The new proton pump inhibitor esomeprazole is effective as a maintenance therapy in GERD patients with healed erosive oesophagitis: a 6-month, randomized, double-blind, placebo-controlled study of efficacy and safety. Aliment Pharmacol Ther. 20‍01;15(7):927‍-9‍35. doi:10.10‍46/j.13‍65-20‍36.20‍01.010‍24.x
  • 11.Scholten T. Long-term management of gastroesophageal reflux disease with pantoprazole. Ther Clin Risk Manag. 20‍07;3(2):2‍31‍-2‍43. doi:10.21‍47/tcrm.20‍07.3.2.23‍1
  • 12.Ruigómez A, García Rodríguez LA, Wallander MA, Johansson S, Graffner H, Dent J. Natural history of gastro-oesophageal reflux disease diagnosed in general practice. Aliment Pharmacol Ther. 20‍04;2‍0(7):75‍1-‍760. doi:10.11‍11/j.13‍65-20‍36.20‍04.021‍69.x

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