Rosh Internal Medicine Boost Practice Exam

What is the next best therapy for a patient with gastroesophageal reflux who is unresponsive to a histamine-2-receptor antagonist?

1. Calcium carbonate

2. Famotidine

3. Omeprazole

4. Sucralfate

The correct answer is: Omeprazole

In cases where a patient is experiencing gastroesophageal reflux disease (GERD) and shows an inadequate response to a histamine-2-receptor antagonist, such as famotidine, the next step in management typically involves the use of a proton pump inhibitor (PPI). Omeprazole, as a PPI, is specifically designed to provide more effective acid suppression compared to H2 blockers. This is crucial because effective reduction of gastric acid secretion can help alleviate symptoms and promote healing of the esophagus lining in patients with GERD. Proton pump inhibitors work by irreversibly inhibiting the hydrogen-potassium ATPase enzyme, which is located in the parietal cells of the stomach lining. By doing so, PPIs significantly decrease gastric acid production, providing more immediate and sustained relief compared to H2 antagonists. They are considered a first-line therapy for moderate to severe GERD, especially in patients who have not responded to other treatments. Considering the other choices, while calcium carbonate can provide temporary relief as an antacid, it doesn’t address the underlying issue of excessive acid production. Famotidine, being another H2 receptor antagonist, would be a duplicate therapy without offering additional benefit. Sucralfate acts as a protective barrier