{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 3, Ep 2 of 3: Acid Suppression Drugs","html":"<iframe width=\"100%\" height=\"180\" frameborder=\"no\" scrolling=\"no\" seamless src=\"https://share.transistor.fm/e/29144051\"></iframe>","width":"100%","height":180,"duration":482,"description":"Acid-suppressing drugs work only when their mechanism and timing line up. This episode explains why proton pump inhibitors heal erosive disease when histamine blockers fade, why wrong meal timing is the top cause of apparent PPI failure, and where vonoprazan changes the game.\n \nTopics covered\n\nOne pump, three switches: gastrin, histamine, acetylcholine\nH2 blockers fade as the cell ramps up\nPPIs are prodrugs that need meal-timed acid\nPPI potency ranking and escalation logic\nNocturnal acid breakthrough on twice-daily dosing\nVonoprazan as a mechanistically different acid blocker\nLong-term safety associations versus randomized data\nClopidogrel and PPI interaction\n \n \nKey decisions\n\nFirst move in apparent PPI failure is confirming dosing 30 to 60 minutes before a meal\nDexlansoprazole is the one PPI that does not need strict meal timing\nPantoprazole is weakest, rabeprazole strongest; switch agents before adding a second dose\nVonoprazan is the answer for true breakthrough after correctly taken twice-daily PPI, especially severe disease\nDo not stop a PPI for safety worry in severe erosive disease, stricture, or Barrett's; use lowest effective dose\nFor dual-antiplatelet patients needing acid suppression, choose low-interaction pantoprazole or rabeprazole, do not withhold\n \n \nThis is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we hope you enjoyed this content.\n \n \nStudy the full chapter on Board Pearls, with practice questions, tables and primary-guideline references: GERD and Refractory Reflux\nRead this episode: boardpearls.com/gi/episodes/gerd-and-refractory-reflux-ep2\nQuestions or feedback: hello@boardpearls.com.","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}