title: [PPI: new strategies for GERD].
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).
authors.affiliation: Department of Internal Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research.
authors.forename: Etsuo
authors.initials: E
authors.lastname: Hoshino
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Ishiyama
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Tsuchida
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000863:Antacids; D001189:Aryl Hydrocarbon Hydroxylases / Q000502:physiology; D001562:Benzimidazoles; D002940:Circadian Rhythm; D065731:Cytochrome P-450 CYP2C19; D003864:Depression, Chemical; D004351:Drug Resistance; D004791:Enzyme Inhibitors / Q000008:administration & dosage* / Q000378:metabolism / Q000494:pharmacology; D005744:Gastric Acid / Q000378:metabolism; D005764:Gastroesophageal Reflux / Q000188:drug therapy*; D006635:Histamine H2 Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D064747:Lansoprazole; D006899:Mixed Function Oxygenases / Q000502:physiology; D009853:Omeprazole / Q000031:analogs & derivatives*; D054328:Proton Pump Inhibitors; D064750:Rabeprazole
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000863:Antacids; D001562:Benzimidazoles; D004791:Enzyme Inhibitors; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D064750:Rabeprazole; D006899:Mixed Function Oxygenases; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D009853:Omeprazole