| [ Summary ] |
Step-up therapy as a treatment strategy for GERD is a classical approach, based on the concept of improving the pathophysiology of GERD by inhibiting GER. The therapy starts with improvements in life style and diet, followed by administration of antacids, mucosal protectants and prokinetics. If this does not achieve improvements in the patient's condition H2RA is administered for 8 to 12 weeks and, if this treatment is still unsuccessful, PPIs are administered. As a therapy, this is a rational and economical approach. Moreover, mild GERD can be treated with this methed. In Japan, there are many cases of mild GERD, in which H2RA treatment can achieve a rate of 60 to 70% successful results. In addition, health care in this country is based on a national insurance system, under which expensive PPI treatment is restricted for these treatment periods. Furthemore, health care insurance fund is in financial difficulty and facing imminent bankruptcy. Accordingly, rational treatment with minimized unnecessary cost is expected in the care of GERD, also. Step-down therapy requires the use of PPIs, even in GERD patients who do not need it, while in step-up therapy, PPIs can be used on a rational basis and also economically by screening GERD patients in whom PPIs are essential. Therefore, under the current circumstances, I recommend Step-up therapy. |