Q: I am 26 years old suffering from GERD for the last five years. I have been on Ganaton (twice a day, morning and night) and Esoz (one tablet in the afternoon after lunch). When should I take Esoz, before or after lunch? Are there any side effects of taking both the drugs? Ganaton was prescribed after I had my endoscopy and Esoz was prescribed by my family doctor. How long should I continue these medicines?

A:Ganaton is the trade name of a medicine called itopride while Esoz contains esomeprazole. In correctly diagnosed cases of non-infective GERD (many cases are due to H. pylori infection that requires antibacterial therapy), esomeprazole and other related compounds such as omeprazole, pantoprazole (Pantodac), lansoprazole are the first line therapy that has been found to be beneficial. In about 40% of the non-infective GERD cases, the movement of the gut is found to be sluggish. In such cases, prokinetic (that promote gut movement) agents such as metoclopramide and domperidone are found to be helpful. Itopride is relatively a new prokinetic drug and has not been approved for use in major, advanced countries such as United States, Canada, Britain, etc. Hence, not much research has gone into its efficacy and safety profile (i.e. adverse effects) after prolonged use. Another prokinetic agent called cisapride was banned several years go for causing heart movement abnormalities that led to fatal outcomes. Doctors in advanced countries in the West use metoclopramide or domperidone in those cases of GERD where it may be required.