Initial Management of Dyspepsia and GERD
Proton Pump Inhibitors (PPI)
Generic Name Trade Name Usual Adult Dose
Esomeprazole Nexium ® 40 mg daily
Lansoprazole Prevacid ® 30 mg daily
Omeprazole Prilosec ® 20 mg daily
Omeprazole NaHCO3 Zegerid ® 20 mg daily
Pantoprazole Protonix ® 40 mg daily
Rabeprazole Aciphex ® 20 mg daily

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[Refer to GERD algorithm]

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Source: Institute for Clinical Systems Improvement (ICSI). Initial management of dyspepsia and GERD. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2006 Jul. 53 p. Initial Management of Dyspepsia and GERD Symptoms of dyspepsia or GERD. A Refer to GERD algorithm Dyspepsia: All male and non-pregnant female adults with pain or discomfort felt to arise in the upper GI tract with symptoms on greater than 25% of days over the past 4 weeks. GERD: Dominant symptom is heartburn or acid regurgitation, does not include atypical manifestations. Are there alarm features? A Endoscopy for alarm features/out of guideline. A Alarm features *Melena. *Persistent vomiting. *Dysphagia. *Hematemesis. *Anemia. *Weight loss greater than 5% (involuntary). Prior documented ulcer? A H. pylori testing, eradication/case management. A Uncomplicated dyspepsia Is patient age 55 or older, or at increased risk of gastric cancer? A H. pylori testing? Is H. pylori infection present? A Treatment for H. pylori. A Empiric trial of full dose PPI/address NSAID use. A Symptoms persist greater than 4 weeks? A Management of symptomatic relapse. A Endoscopy Endoscopy positive? A Case management/Out of guideline. A Continue treatment for 8 weeks total course and then stop. A Functional dyspepsia. A Patient has relapse within 12 months? A = Annotation Resolved dyspepsia