Editing GORD (section)

=== '''Medical''' ===

** PPI
*** Irreversibly binds the H+,       K+-ATPase proton pump in parietal cells
*** Require an acidic       environment to be activated - may not work properly with       sucralfate/antacids
*** Maximal pharmacologic       effect occurs about 4 days after initiation, and effect lasts for the       life of the parietal cell (1 week)
*** Maximal: BD PPI
*** Side effects
**** Short-term: headache, abdo        pain, flatulence, constipation, diarrhoea
**** Reports of long-term        associations with dementia and bone density issues are based on        observational studies and are hard to prove. 2024 expert opinion is        that these risks should be de-emphasised. The true long-term risks are        probably slightly higher risk of gut infection and electrolyte        irregularities, including hypomagnesaemia.
** H2-receptor antagonists
*** Inhibit the histamine       receptor on the parietal cell
*** Famotidine is the most       potent, followed by ranitidine, nizatidine, and cimetidine
** Antacids
*** Contain aluminium       hydroxide, calcium carbonate, or magnesium trisilicate
*** Magnesium antacids - best       buffers, but can cause diarrhoea
*** Phosphorus antacids -       occasionally result in hypophosphataemia and constipation
*** Neutralise gastric acid and       decrease acid delivery to the duodenum, although the precise mechanism       is unclear
** Sucralfate
*** Sucrose octasulfate       complexed with aluminium hydroxide
*** Binds to injured gastric       tissue and simulates angiogenesis and granulation tissue formation
*** Lasts for about 6 hours