Role of the primary care provider in the diagnosis and management of heartburn

Abstract

Background:

Heartburn affects an estimated 42% of the US population. Often, patients are able to recognize symptoms and self-treat heartburn; however, patients with more persistent and/or troublesome symptoms should be evaluated by a physician or other healthcare provider.

Scope:

This review focuses on the role of the primary care provider in the diagnosis and treatment of heartburn.

Methods:

A search was conducted on PubMed (to November 2009) and articles relevant to the management of heartburn by a primary care provider topic were selected.

Findings:

Diagnostic tools, such as endoscopy, and ambulatory pH monitoring, are recommended for advanced assessment of patients with frequent heartburn to avert misdiagnosis and to identify complications of reflux disease. Over-the-counter and prescription treatments for frequent heartburn symptoms include antacids, histamine₂-receptor antagonists (H₂RAs), antacid/H₂RA combinations, and proton pump inhibitors (PPIs). Among these, PPIs represent the mainstay of acute and maintenance treatment regimens in reflux disorders and are more effective than H₂RAs for long-term use due to the development of tolerance to the latter therapy. While once-daily PPI therapy may be sufficient in most patients, a few may require twice-daily PPI therapy to alleviate their symptoms. This review is limited by its relatively narrow focus on articles cited in PubMed.

Conclusion:

The primary care provider is ideally situated to advise patients on the best treatment option for their condition and to provide follow-up care if required.

Key words::

• Antacids
• Heartburn
• Histamine₂-receptor antagonists
• Inhibitors, proton pump
• Primary care provider
• Quality of life

Transparency

Declaration of funding

Funding for editorial support was provided by Novartis Consumer Health, Inc. The opinions expressed in the current article are those of the author. The author received no honoraria or other form of financial support related to the development of this manuscript.

Declaration of financial/other relationships

P.R.K. has disclosed serving as a speaker and consultant to Novartis Consumer Health, Inc.

Peer reviewers may receive honoraria from CMRO for their review work. Peer Reviewers 1 and 2 have disclosed that they have no relevant financial relationships.

Acknowledgments

The author would like to acknowledge Shilpa Lalchandani and Roderick H. Sayce from Embryon, for medical writing assistance and editorial support (for which funding was provided by Novartis Consumer Health, Inc.).