If there is a response to acid - suppressive therapy (generally PPIs), a diagnosis can be assumed.

Caution should be used with chronic acid suppression from H2 - blockers and PPIs due to recent concerns of increased _________, ________, _______ and _______ with long term use.

fracture risk; increased risk of GI infections; increased risk of nosocomial pneumonia in hospitalized patients; increased risk of osteoporosis

Use OTC  products 1^st, and use Rx products only as necessary.

In more serious conditions (in which esophageal erosion is present), PPIs should be used first - line b/c they are the most effective agents at acid - suppression.

Misoprostol and sucralfate are difficult to use and seen infrequently. With these agents, there are a few important safety considerations. American College of Gastroentology (ACG) recommends against the use of metoclopramide as therapy for esophageal symptoms (risk outweighs benefits); however, it is still used commonly in the elderly, where it can pose significant risk of adverse events.

neutralize acid in buffering reaction (producing salt and water), which raises pH.

Weaskest clas of agents. Work fast, but don't last long - use as-needed (<2 times/week) for immediate relief.

contains bismuth subsalicylate (for upset stomach and diarrhea - will darken stool, avoid in salicylate allergy)

Separate 2 hours before, 4 hours after from quinolones and tetracycline antibiotics (reduced drug absorption due to chelation)

Seperate 2 hours before, 4 hours after from itraconazole, ketoconazole, calcium carbonate and iron, due to reduced absorption from increased pH

Do not use aluminum or magnesium products if you have advanced _____ disease.