Use of Proton Pump Inhibitors is considered appropriate in the following:

1. Refractory severe erosive or reflux esophagitis after treatment failures (at least 4 weeks therapy) with H2 antagonist.
2. Endoscopically proved grade 3 or 4 reflux esophagitis.
3. Endoscopically proved duodenal or gastric ulcer.
4. In combination therapy for H.pylori .
5. Pathologic hypersecretory conditions refractory to previous treatment: Zollinger-Ellison syndrome, systemic mastocytosis, multiple endocrine adenomas as documented by basal acid secretion > 10 mEq./hr and/or serum gastrin >150 pcg/ml.

1. Omeprazole – 20mg (occasionally 40mg) Lansoprazole - 30mg daily
2. For Indication #4 – dosing may be twice daily
3. For Indication #5 – larger doses titrated to effect - see literature
4. Reduce the dosage in liver disease

1. No concurrent therapy with H2 antagonist
2. Sucralfate not given concurrently longer than 5 days.
3. Drug/drug interactions with diazepam, phenytoin, theophylline, warfarin
4. Side effect of headache, diarrhea, abdominal pain, nausea
5. Drug administered 1 hour before meals or patient counseled to take 1 hour before meals
6. Crushing for liquid administration only under pharmacy supervision.

1. Increased gastric pH (if nasogastric tube in place)
2. Healing documented by endoscopy after 4-8 weeks therapy
3. Improved pain control – symptomatic relief.