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If youre high-risk (active GI symptoms, recent dose increase, known delayed emptying), your team may use a liquid diet the day prior, point-of-care gastric ultrasound, or a brief medication hold

This allows the water to remain sterile for up to 28 days after opening, making it ideal for reconstituting peptides in research settings

But it does suggest the mechanism is worth understanding if you're dealing with reflux that hasn't responded to proton pump inhibitors or lifestyle changes alone

They remain effective throughout this window