Symptoms:

 Epigastric pain (pain in upper part of stomach)

 Pyrosis (Heartburn)
 Belching (burping)
 Waterbrash (Excess salivation)
 Persistent cough

Clinical Findings:

 Epigastric tenderness on palpation

Treatment:

LIFESTYLE MODIFICATIONS

 Short & small frequent meals (every 4-5 hours)

 Have dinner 3-4 hours prior to sleeping
 Avoid spice, oily food and smoking
 Avoid soda drinks and excessive tea at night
 Don’t lie down immediately after meal
 Drink plenty of water
 Keep head end elevated NOT by putting pillows but by putting bricks under the head end of
bed.

PHARMACOLOGICAL THERAPY

1. ANTACIDS
Meds containing salts of aluminium, calcium, magnesium, or sodium.
 Syp Gaviscon (2 TSF BD)
 Syp Mucaine (2 TSF BD) TSP: teaspoon Tbsp: tablespoon

2. H2 RECEPTOR BLOCKERS
Mnemonics: FaNCi
 Famotidine (Apsin)
 Nizatidine (Simko)
 Cimetidine (Cimet, Tagamet)

Dose: 1tab HS (Before bed time)

3. PROTON PUMP INHIBITORS (PPIs)

Mnemonics: OLPER / POLER
 Omeprazole (Riske, Ruling)
 Lansoprazole (Inhibitol)
 Pantoprazole (Zopent)
 Esomeprazole (Esocue, Nexum)
 Rabeprazole (Promto, Rabecid)

Dose: 20-40mg OD (once a day) for 14 days

 Note: Always taken 30-45mins BEFORE BREAKFAST

In case of persistent symptoms:

 OMPERAZOLE 40mg OD Half hour before breakfast 2-4 weeks at least

In case of both day time symptoms & nocturnal cough (cough at night):

 OMPERAZOLE 20mg OD Before Breakfast + CIMETIDINE 400mg HS (before bed time) 2-4
weeks.

PRACTICAL TIP:

If on follow up patient claims to see improvement and found responding to medications then

 Always taper off the dose.

 NEVER DISCONTINUE PPIs ABRUPTLY, it will cause recurrence of symptoms.