Gastroenterology Primary care

Primary care gastroenterology
Oral bisphosphonates have been linked to esophageal adenocarcinoma and squamous cell carcinoma according to a post-marketing US Food and Drug Administration (FDA) letter . The FDA recommends that oral bisphosphonates not be used in patients with Barrett's esophagus.A randomized trial compared a "step down" with a "step up" approach (ie, beginning with antacids and advancing to H2 receptor antagonists and then proton pump inhibitors) in patients with new onset dyspepsia seen in the primary care setting . After six months, the success rates were similar but the step-up approach was associated with lower overall costs.