1. Proton Pump Inhibitors
Appropriate Use in General Practice

2. Life before PPIs The history of dyspepsia Surgery and diet
Vagotomy/Pyloroplasty
Steamed fish and milk puddings
H2-receptor antagonists
Tagamet & SKF
Zantac & Glaxo

3. Proton Pump Inhibitors
Losec (Omeprazole)(Astra)
Zoton (Lansoprazole)(Wyeth)
Pariet (Rabeprazole)(Janssen)
Nexium (Esomeprazole)(Astra)

4. NICE Guidance Issued in 2000
Targeted use to make best use of resources

5. Dyspeptic Symptoms Diagnosed or not? Non-ulcer Dyspepsia
Peptic Ulceration
GORD

6. Peptic Ulceration Helicobacter-related? NSAID-related? ERADICATE
Co-Prescribe PPI if cannot stop NSAID

7. Gastro-Oesophageal Reflux
Severe
healing dose PPI until symptoms controlled
maintenance dose to prevent recurrence
Complicated
stricture, ulcer, haemorrhage etc
full dose maintained
Mild
alternative Rx: antacid, alginate, H2RA

8. Non-ulcer Dyspepsia Use Acid Suppressor (H2RA) NOT PPI
Step-up or Step-down

9. Investigation Over 55 ENDOSCOPY Alarm Symptoms ENDOSCOPY
dysphagia
anaemia
progressive weight loss
Under 45 NO INVESTIGATION
DEBATABLE