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Daily Medical Update
Gastroesophageal Reflux Disease (GERD, PPI safety)
Wednesday, February 18, 2026
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🔬 Practice‑Changing Findings
Evidence from RCTs and meta‑analyses published in the last 12 months.
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Journal of Gastroenterology and Hepatology (2026) - Randomized Controlled Trial
Key Findings
- In adults with persistent nocturnal reflux on morning PPI, wedge pillow plus morning PPI was noninferior to adding an evening PPI (NGSSIQ mean difference -6.32; 95% CI -10.28 to 6.21 within noninferiority margin).
- Sleep quality improved more with wedge pillow than twice-daily PPI (5.55±0.56 vs 7.53±0.60; p=0.001), with high patient satisfaction (83.3%).
📋 Practice Implication: For nocturnal breakthrough symptoms, a wedge pillow can be offered before escalating to twice-daily PPI.
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BMC Gastroenterology (2026) - Meta-Analysis of RCTs
Key Findings
- Across 10 RCTs (n=5,133), P-CABs showed higher short-term efficacy than PPIs (RR 0.72; p=0.02), with stronger signals in Asian cohorts (RR 0.69; p=0.01).
- Adverse-event rates were similar overall, and superiority was most apparent versus lansoprazole (RR 0.50; p<0.001) but not esomeprazole (p=0.93).
📋 Practice Implication: P-CABs are reasonable first escalation options when rapid symptom control or healing is needed after inadequate response to standard PPI.
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Digestive Diseases and Sciences (2026) - Systematic Review/Meta-Analysis
Key Findings
- Meta-analysis of 6 studies found higher serum gastrin with P-CABs versus PPIs (mean difference 130.92 pg/mL; 95% CI 36.37-225.47).
- Most adverse events were uncommon (<5%), serious adverse events remained <10% in most studies, but fracture signal was about threefold higher in P-CAB groups.
📋 Practice Implication: If selecting a P-CAB, add follow-up planning for safety (gastrin trends, hepatic effects, and bone-risk review) rather than assuming class equivalence with PPIs.
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Alimentary Pharmacology & Therapeutics (2026) - Network Meta-Analysis
Key Findings
- Six RCTs (n=2,864) showed vonoprazan 20 mg outperformed lansoprazole 30 mg for early erosive esophagitis healing at 2 weeks.
- Eight-week regimens provided better outcomes than 2-week treatment, and efficacy was lower in severe LA C/D disease than LA A/B across acid-suppressive options.
📋 Practice Implication: In erosive disease, consider stronger acid suppression (e.g., vonoprazan where available) and avoid premature 2-week stop points, especially in LA C/D disease.
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Recent GERD evidence supports a stepwise strategy that can reduce unnecessary PPI intensification while identifying where newer acid suppressants may improve short-term healing. P-CABs show efficacy advantages in several RCT syntheses, but safety monitoring (especially gastrin-related effects) remains important. For nocturnal breakthrough symptoms, non-drug positioning interventions can be clinically competitive with adding evening PPI dosing.
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