What is the next best therapy for a patient with gastroesophageal reflux disease experiencing persistent symptoms on a histamine-2-receptor antagonist?

The next best therapy for a patient with gastroesophageal reflux disease (GERD) who continues to experience persistent symptoms on a histamine-2-receptor antagonist, such as famotidine, is a proton pump inhibitor (PPI) like omeprazole.

Histamine-2-receptor antagonists work by reducing stomach acid production, but they may not provide sufficient symptom relief for some patients with GERD. In such cases, PPIs are more effective at decreasing gastric acid secretion and promoting healing of the esophageal lining, making them a preferred choice for those with ongoing symptoms despite the use of H2 blockers.

Using a PPI like omeprazole can lead to better management of GERD symptoms as it provides a more significant acid suppression. This class of medication is particularly beneficial for patients who have erosive esophagitis or severe GERD.

Calcium carbonate, while an antacid, provides only temporary relief and is not suitable for long-term management. Repeating the same H2-receptor antagonist, such as famotidine, will not address the persistent symptoms effectively. Sucralfate acts as a mucosal protectant rather than directly suppressing acid secretion and is less effective in controlling symptoms related to excess stomach