NA is a 48 yo man with hypertension and GERD who is following up in clinic after starting pantoprazole 40 mg daily.

NA is a 48 yo man with hypertension and GERD who is following up in clinic after starting pantoprazole 40 mg daily. He says that he takes the PPI in the morning and usually skips breakfast. He doesn’t think the pantoprazole has been helping with his heartburn, which he has almost every day and is worse with dinner. Which is the most appropriate recommendation to give NA? NA is a 48 yo man with hypertension and GERD who is following up in clinic after starting pantoprazole 40 mg daily. He says that he takes the PPI in the morning and usually skips breakfast. He doesn’t think the pantoprazole has been helping with his heartburn, which he has almost every day and is worse with dinner. Which is the most appropriate recommendation to give NA? Increase pantoprazole to twice daily Instruct him to take the PPI 30-60 minutes before a meal He has failed PPI therapy and a further diagnostic evaluation is warranted Tell him to crush the pantoprazole so it will be better absorbed