Red Flags
• Patients with “alarm” symptoms such as chronic bleeding from the gastrointestinal tract, unintentional weight loss, progressive swallowing difficulties, iron-deficiency anemia, progressive dysphagia, suspicious barium meal examination, persistent vomiting, and epigastric mass should referred immediately for endoscopic investigation
• Long-term use of PPIs has been linked to GI disturbances (e.g., diarrhea, constipation, nausea, vomiting), recurrence of Clostridium difficile infection, and, in postmenopausal women, spine, lower arm, and total fractures
• Antacids are contraindicated if renal disease is present; antacids should be used with caution if other medications are being taken, as antacids can decrease absorption and action of other drugs (digoxin, iron salts, tetracycline, and fluoroquinolones)