For GERD treatment, PPI has the strongest acid-suppressive effect Prof. Yuan pointed out that the diagnosis of gastroesophageal reflux disease (GERD) is mainly based on symptoms, but recent literature suggests that this diagnosis can miss some problems, such as empirical treatment with PPI given before the endoscopic diagnosis is clear may lead to misclassification of GERD and wrong diagnosis of non-erosive GERD (NERD). It is advisable to give endoscopy to patients with GERD symptoms to better help clarify the diagnostic classification. GERD treatment should be considered in four ways: (1) lifestyle changes; (2) suppression of gastric acid secretion. (3) application of prokinetic drugs; (4) administration of surgical and endoscopic treatment. In most patients, acid suppression therapy resolves the symptoms. Proton mercury inhibitors (PPIs) are the most commonly used drugs in the treatment of GERJ because of their strong acid-suppressing ability. There are five PPIs (Wmeprazole, lansoprazole, pantoprazole, rabeprazole and esomeprazole) available in China. The standard dose of the new generation PPI has stronger acid-suppressive effect. PPI and clopidogrel combination day prudent choice Professor Yuan said that a study published in the Journal of the American Medical Association (JAMA) on March 4, 2009, suggested that patients with acute coronary syndrome (ACS) receiving clopidogrel along with PPI increased the risk of ACS readmission. in October 2010, the FDA again cautioned to avoid the combination of clopidogrel and Wmeprazole. “Pantoprazole has weak inhibition of CYP2C19 and has little effect on clopidogrel activity compared with Wmeprazole, making pantoprazole a more worthwhile option to consider if combined with clopidogrel.” A 2010 study published in the New England Journal suggested that the combination of a PPI (compared with placebo) reduced the risk of upper gastrointestinal bleeding in patients on dual antiplatelet therapy with clopidogrel and aspirin. No serious cardiovascular side effects were found with the combination of clopidogrel and PPI. Six Expert Consensus Opinions In most of the foreign and domestic consensus opinions, gastric acid suppression is considered as the main measure for the current treatment of GERD, among which PPI has strong acid suppression ability. The consensus also establishes the active use of PPIs in patients treated with antiplatelet or (and) non-steroidal anti-inflammatory drugs. Professor Yuan highlights that PPIs should be used in accordance with a new consensus opinion developed by experts from the American College of Cardiology Foundation (ACCF), the American College of Gastroenterology (ACG) and the American Heart Association (AHA), which was published in 2010 in the American The consensus was published in the 2010 issue of the American Heart Association’s Ciculation journal. (1) The risk of upper gastrointestinal bleeding is reduced with the addition of a PPI or H2 receptor blocker (H2RA) compared with antiplatelet agents alone, and PPIs are more effective than H2RA. (2) For patients requiring antiplatelet therapy, PPIs are recommended for patients with a history of gastrointestinal bleeding and for those with multiple other risk factors for bleeding. PPI can be considered for the prevention of gastrointestinal bleeding. (3) Routine prophylactic use of PPI or H2RA is not recommended for patients at low risk of upper gastrointestinal bleeding. (4) The balance between cardiovascular benefit and gastrointestinal bleeding complications needs to be carefully weighed in each case before deciding whether prophylactic use of PPI in conjunction with antiplatelet therapy is warranted. (5) Pharmacological studies have shown that concomitant use of clopidogrel and PPI may (5) Pharmacological studies have shown that concomitant application of clopidogrel with PPIs can reduce the antiplatelet efficacy of the former, with omeprazole having the most significant effect on clopidogrel, but it is unclear whether this effect is clinically important. (6) The available studies have not reached a consistent conclusion as to whether the concomitant use of clopidogrel and PPI may increase the incidence of cardiovascular adverse events. However, for some specific populations, such as patients with poor clopidogrel metabolism, the possibility of a clinical interaction cannot be ruled out.