In bacterial esophagitis, achieving adequate symptom control — particularly around nocturnal acid breakthrough and GERD symptoms — is the central treatment objective. When acid suppression is insufficient, the clinical approach involves systematic adjustment of the suppression strategy.
This protocol applies to patients with bacterial esophagitis whose current acid-suppression regimen is not providing adequate control of nocturnal acid breakthrough or GERD symptoms.
Management involves targeted modifications to acid-suppression therapy — including changes to the agent, regimen structure, or agent class — chosen based on the pattern of inadequate response. The complete decision algorithm, options, and sequencing are in the full protocol.
Reduction of nocturnal acid breakthrough and GERD symptoms.
DOI: 10.14218/JTG.2025.00006
For those who remain refractory to PPI therapy, consideration should be given to switching the PPI or trying double-dose therapy, using a PPI agent twice daily before breakfast and dinner to improve symptoms.
Adding an H2RA at night to twice-daily PPI therapy has been shown to reduce nocturnal acid breakthrough and GERD symptoms.
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