Acid reflux/GERD


  • GI cocktail:
    1. Maalox X-ST (ALOH/MGOH/Simet) 30ml PO X 1 dose
      1. Magnesium Hydroxide (MOM) oral suspension
    2. Lidocaine (Xylocaine) 2% viscous 15ml PO X 1 dose
  • Maalox 30cc, Mylanta,
  • Scheduled Protonix/Omepraxole
  • Scheduled and/or PRN Ranitidine


  • Encourage lifestyle changes: Do not eat large meals close to bedtime, prop up the head of the bed, eat multiple smaller meals rather than large meals.
  • Prilosec (Omeprazole): Remind pt to take this 30-45 minutes BEFORE a meal to be effective.
    • May need to increase from qd to BID.
  • Pepcid (Famotidine) or Zantac (Ranitidine): effectiveness not associated with timing around meals.
    • Pepcid can cause altered mental status in elderly!
  • Patient may need to be referred to GI for upper endoscopy (EGD).
    • If Barrett’s esophagus is present, recommend repeat EGD in 1 year.
  • NO NSAIDS! (includes “BC powder,” which is mainly aspirin in powder form).
  • Consider starting Reglan (Metoclopramide): pro-motility, increases LE sphincter tone too?
  • Example Tx plan:
    • Start Ranitidine (H2 blocker) 150mg PO bid PRN “heartburn.”
    • Also take Dexlansoprazole (Dexilant) (PPI) 30mg PO qPM.
      • Recommend taking PPI (Dexilant) 30-45 minutes BEFORE breakfast each day.
    • Recommend AVOIDING NSAIDS and to only use Tylenol PRN for pain relief.
  • Order pylori IgM antibody test (blood):
    • Other option: EGD (physically look for peptic ulcer and collect biopsies of tissue
    • Tx: Clarithromycin 250mg PO bid, Amoxicillin 500mg PO bid, and PPI (Protonix 40mg PO qd)

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