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Comparative Effectiveness of Management Strategies for Adults With Gastroesophageal Reflux Disease: An Update

Slide: 7 of 26

Background: Additional Issues

There are additional issues to consider in the management of patients with GERD:

  • There is no consensus about the optimal approach to evaluate and manage patients with GERD that is refractory to medical management.

  • The diagnosis of extraesophageal GERD presentations such as asthma, cough, and laryngeal symptoms is challenging because: a) the relationship between GERD and these symptoms is not as strong as that seen with typical symptoms like heartburn, b) these complaints may have a multifactorial etiology (for instance, allergies), and c) improvement of these symptoms after GERD treatment is less predictable.

Another important issue to consider is that an October 2010 reminder from the U.S. Food and Drug Administration warns that the concomitant use of clopidogrel and the PPI omeprazole (Prilosec®) can result in significant reductions in the antiplatelet activity of clopidogrel.

Abbreviations:
GERD = gastroesophageal reflux disease
PPI = proton pump inhibitor