Duration of treatment with high-dose PPIs in GERD

What should be the duration of high-dose proton pump inhibitor (PPI) treatment in a patient with gastroesophageal reflux disease?

Janusz Jankowski, MD, PhD: The minimum dose we recommend is 8 weeks, simply because it takes that length of time to treat the inflammation which is caused by the reflux disease, but it is very common for people to actually extend that treatment up to 6 months. Hopefully by that stage some lifestyle measures would have kicked in and actually had some operation with the patient so that they have got much less symptoms, they have dropped some weight, changed their eating habits, changed the diet itself, and maybe raised the end of the bed.

In a proportion of patients that 6-monthly treatment and review will be extended for many years. If you follow up all the patients who start on acid suppressant treatment, you will find that 70% of them gradually wean off from the higher dose, down to the low dose, on to as-needed (prn) dose, and sometimes stop. But approximately 30% of people will escalate, will need a higher dose of therapy and will never be able to be weaned off the high dose that they may have started with.