The step-down approach to the management of reflux disease Antacid/ alginate H 2 - antagonist Half-dose PPI Full-dose PPI Kinnear M et al.
{"Image DocumentName": "The step-down approach to the management of reflux disease", "Image ImageDescription": "The \u2018step-down\u2019 approach provides rapid symptom relief, is efficient for GPs, and may be the preferred choice for the empirical therapy of reflux disease. Antacid/ alginate. H2-antagonist. Half-dose PPI. Full-dose PPI. Step-down \u2013 an evidence-based approach to the management of reflux disease. Much debate has surrounded the relative merits of the step-up and step-down approaches to the management of reflux disease. The Genval workshop recommended that, for initial therapy of oesophagitis, the most effective approach is to start patients with a PPI, followed by trials of stepping down to the lowest class while still controlling symptoms. This management strategy is also considered to be the most cost-effective by the Genval workshop. 1 The British Society of Gastroenterology dyspepsia guidelines state that, whatever approach is taken, attempts should be made to titrate to the drug that provides relief from symptoms at the lowest cost with the least influence on normal physiology.2. Dent et al suggest that the most effective therapy should be administered first. The rapid symptom control achieved should offset the higher initial drug cost and reduce the need for repeat consultation.3. Other guidelines, such as the Paris consensus statement,4 recommend a step-up approach to the treatment of reflux disease. No data are available comparing the two approaches but both agree that the primary goal should be to control the symptoms of reflux disease within a short period of time.5. References. 1. Dent J, Brun J, Fendrick AM, et al. Gut 1999; 44 Suppl 2: S1\u2013S BSG, Dyspepsia management guidelines. Guidelines in Gastroenterology Sept Dent J, Jones R, Kahrilas P. et al. BMJ 2001; 322: Conference de Consensus Franco-Belge. Gastroenterol Clin Biol 1999; 23: 56\u2013 Heading RC. Prescriber 2000: March; 95\u2013101. Kinnear M et al : NICE 2000.", "Image XResolution": "37", "Image YResolution": "37", "Image ResolutionUnit": "Pixels/Centimeter", "Image Software": "SlidePlayer", "Image YCbCrPositioning": "Centered"}