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Table 3 Current indications of proton pump inhibitor (PPI) therapy

From: Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Clinical setting PPI dose and duration
GERD  
 Erosive Esophagitis (A/B) Standard dose PPI therapy for 8-12 weeks
 Erosive Esophagitis (C/D) Double dose PPI therapy for 8-12 weeks
 NERD Standard dose PPI therapy for 4-8 weeks
 Long-term Management (both GERD and NERD) Standard (or half) dose PPI maintenance (continuous, intermittent or on-demand, depending on clinical characteristics of the patient)
 Barrett’s Esophagus Long-term individually-tailored PPI therapy
 Extra-digestive GERD Standard or double-dose PPI therapy for at least 12 weeks
Eosinophilic Esophagitis Standard or double dose PPI therapy for 8-12 weeks
H. pylori Eradication Double dose, twice daily, PPI therapy for 7-14 days (in combination with antimicrobials)
Non H. pylori-related PU disease Standard dose PPI therapy for 4-8 weeks
Zollinger-Ellison Syndrome High-dose (eventually twice daily) long-term PPI therapy
Stress Ulcer Prophylaxis in patients with risk factors Standard PPI therapy by intravenous route only during ICU stay
Dyspepsia  
 Uninvestigated Dyspepsia in Patients younger  than 45 yrs Standard or half-dose empiric PPI therapy for 4 weeks
 Functional Dyspepsia (EPS phenotype) Standard or half dose PPI therapy for 4-8 weeks
NSAID-gastropathy  
 Prevention of gastro-duodenal lesions and  events Standard or half-dose PPI therapy, starting form the very first dose of NSAID in patients at GI risk
Treatment of gastro-duodenal lesions Standard dose PPI therapy for 8 weeks
Steroid therapy No need for gastroprotection unless used in combination with NSAIDs
Anti-Platelet Therapy Standard dose PPI therapy, starting form the very first dose of antiplatelet agent in patients at GI risk
Anti-Coagulant Therapy No need for gastroprotection unless used in combination with antiplatelet therapy
PU Bleeding Intravenous bolus of 80 mg of the available injectable PPIs, followed by 8 mg/h for 72 hours
Cirrhosis  
 Hypertensive gastropathy No need for acid suppression
 Prevention or/and treatment of esophageal ulcers  after sclerotherapy or variceal band ligation Standard dose PPI therapy for 10 days (longer treatment should be avoided taking into account the risk of spontaneous bacterial peritonitis)
Pancreatic Diseases  
 Acute pancreatitis No benefits from acid suppression
 Chronic pancreatitis Standard PPI therapy only in patients with steatorrhea, refractory to enzyme replacement therapy