NAMA : LINGGAR DWI CAHYANINGRUM

NIM : 201710330311101

Soal 1

A 23 year-old patient came to your practice with heartburn and sore throat. Later he was diagnosed
as gastroesophageal reflux disease. You have heard in your last symposia that PPI (protone pump
inhibitor) drugs have better effect in reducing symptoms than H2- blockers. You would like to prove
whether there are enough evidence to support that statement

PICO QUESTION TERMS SYNONYMS

Population Patient young
Intrevention Drugs PPI (protone pump -
inhibitor)
Comparison h-2 blockers histamine H2-receptor
antagonists
Outcome gastroesophageal reflux heartburn and sore throat

Penelitian farmakologi menguji dan membuktikan apakah obat PPI (inhibitor pompa proton)
memiliki efek yang lebih baik untuk mengurangi gejala daripada H2-blocker.

Dalam jurnal pubmed ditemukan : 3 jurnal

Dalam jurnal cochrane ditemukan : 13 jurnal

Terapi : pemberian obat PPI

Proton pump inhibitors (PPIs) have been shown to be the most effective class of medication to treat
gastroesophageal reflux disease (GERD).

Sumber : PPI use in the OTC era: who to treat, with what, and for how long?
Inadomi JM, Fendrick AM.
Clin Gastroenterol Hepatol. 2005 Mar;3(3):208-15.
strategi alternatif yang digunakan dalam praktik klinis, termasuk obat kombinasi (H2RA plus antasid),
modifikasi gaya hidup yang dikombinasikan dengan obat, dan penggunaan jangka pendek (dua
minggu) dari PPI sesuai kebutuhan

sumber : Short‐term treatment with proton pump inhibitors, H2‐receptor antagonists and
prokinetics for gastro‐oesophageal reflux disease‐like symptoms and endoscopy
negative reflux disease

Kirsten E Sigterman, Bart van Pinxteren, Peter A Bonis, Joseph Lau, Mattijs E Numans

Prognosis : PPI sangat efektif dan lebih baik daripada h-2 blockers

PPIs are more effective than H2RAs in relieving heartburn in patients with GORD who are treated
empirically and in those with ENRD, although the magnitude of benefit is greater for those treated
empirically

Sumber : Short‐term treatment with proton pump inhibitors, H2‐receptor antagonists and
prokinetics for gastro‐oesophageal reflux disease‐like symptoms and endoscopy
negative reflux disease

Kirsten E Sigterman, Bart van Pinxteren, Peter A Bonis, Joseph Lau, Mattijs E Numans
Deprescribing PPIs may lead to side effects such as inflammation of the esophagus. Very few data
were available to make a conclusion regarding long‐term benefits and harms of PPI reduction or
discontinuation.

Sumber : Deprescribing versus continuation of chronic proton pump inhibitor use in adults

Taline A Boghossian, Farah Joy Rashid, Wade Thompson, Vivian Welch, Paul Moayyedi, Carlos Rojas‐
Fernandez, Kevin Pottie, Barbara Farrell

Etiologi :
The availability of over-the-counter (OTC) and generic PPIs provides consumers with options other
than antacids and histamine 2 -receptor antagonists (H2RAs) for self-medication of heartburn and
acid regurgitation. Medical concerns arising from these developments include management of
patients in whom symptoms persist despite OTC PPI, proper administration of PPIs, and potential
masking of more serious pathology, such as malignancy. Current studies indicate that it is likely that
different forms of PPI administration will become more acceptable, such as on-demand and
intermittent therapy. Prospective clinical trials show the efficacy of these strategies of
noncontinuous PPI administration, and the potential for cost reduction in GERD management.
Newer agents such as reversible acid pump antagonists will compete for selected markets in the
future, further expanding the role of alternative dosing regimens. Ultimately, therapy should be
tailored to individual patients because no single strategy will be optimal for the entire population
with GERD symptoms.

Sumber : PPI use in the OTC era: who to treat, with what, and for how long?

Inadomi JM, Fendrick AM.

Clin Gastroenterol Hepatol. 2005 Mar;3(3):208-15.

Diagnosis :

Gastroesophageal Reflux Disease

The American College of Gastroenterology's (ACG) Guidelines for the Diagnosis and Management of
Gastroesophageal Reflux Disease recognizes that GERD is "defined by consensus and as such is a
disease comprising symptoms, end‐organ effects and complications related to the reflux of gastric
contents into the esophagus, oral cavity and/or the lung" (Katz 2013). The ACG categorizes GERD
based on endoscopic findings: nonerosive GERD (NERD) is symptomatic GERD with negative
endoscopy, while GERD with erosive findings on endoscopy is referred to as erosive reflux disease or
erosive esophagitis (EE) (Katz 2013). In 2006, the Global Consensus Group published the Montreal
Definition and Classification of GERD to determine a globally acceptable definition that would be
useful for patients, practitioners, and health agencies. This group defined GERD as, "a condition
which develops when the reflux of stomach contents cause troublesome symptoms and/or
complications", such as heartburn, regurgitation, and esophageal injury (i.e. reflux esophagitis) (Vakil
2006).

Sumber : Deprescribing versus continuation of chronic proton pump inhibitor use in adults

Taline A Boghossian, Farah Joy Rashid, Wade Thompson, Vivian Welch, Paul Moayyedi, Carlos Rojas‐
Fernandez, Kevin Pottie, Barbara Farrell