Is there a limit to how long a patient with gastroesophageal reflux disease (GERD) symptoms can be treated with a proton pump inhibitor (PPI)?—NISHA DESHPANDE, MS, PA-C, Des Plaines, Ill.  

While PPIs have been found to be superior to histamine-2 receptor antagonists (H2RAs) for the treatment of GERD, there are safety issues associated with long term PPI therapy. Potential risks include variations in bioavailability of common medications, Clostridium difficile-associated disease, community-acquired pneumonia, and hip fracture. As with many situations in medicine, the benfit must be measured against the risk. The American Gastroenterological Association Institute recommends determining the least potent therapy (i.e., PPI, H2RA, antacid) that controls acute GERD in individual patients and then continuing this therapy for eight weeks. After eight weeks, the patient should be given a trial off the medication. If symptoms recur in fewer than three months, the patient will most likely need maintenance therapy. Maintenance therapy can be intermittent or continuous. Upper endoscopy should be performed if there is doubt about the diagnosis or any alarm symptoms suggesting another diagnosis are present.—JoAnn Deasy, PA-C, MPH (139-6)