Partnership in optimizing management of reflux symptoms: a treatment algorithm for over-the-counter proton-pump inhibitors

Abstract

Background:

Uncomplicated heartburn and acid regurgitation are increasingly treated and managed using over-the-counter medications. However, with over-the-counter availability of antacids, alginates, histamine 2 receptor antagonists (H2RAs), and proton-pump inhibitors (PPIs), consumers need guidance as to appropriate options and how to use them.

Methods:

Relevant guidelines, studies, and reviews were identified via literature searches of PubMed/Medline and Google Scholar, as well as cross-referencing from the identified papers.

Results:

Antacids, alginates, and H2RAs are best suited to management of occasional heartburn, taken either before provocative meals or other triggers or on demand when symptoms arise. Over-the-counter PPIs are appropriate options across the range of symptom severity/frequency typically encountered in the pharmacy, but may be particularly appropriate for treatment of those with frequent and/or very bothersome heartburn. A 2–4 week course of daily PPIs can lead to complete resolution of frequent heartburn. Counseling is important to ensure that patients understand that failure of symptoms to resolve or a rapid return of symptoms while taking a PPI is an indication to consult a doctor, whereas a return of symptoms after a period of months may be an indication for just another course of treatment. The need for effective communication and for ensuring use of the correct medication in the over-the-counter setting puts much of the responsibility for management of heartburn and acid regurgitation on the pharmacist. A proposed algorithm that details when and how to use available over-the-counter medications is presented. This algorithm also highlights alarm features and atypical symptoms indicative of other underlying conditions that should be referred directly to a physician.

Conclusion:

Implementation of a simple algorithm will empower pharmacists and consumers alike and ensure consistent and appropriate care.

Keywords: :

• Alginates
• Antacids
• Gastroesophageal reflux
• Heartburn
• Histamine 2 receptor antagonist
• Proton-pump inhibitors

Transparency

Declaration of funding

Pfizer provided funding to support the writing of this paper, but full control of the content remained with the authors. All authors contributed to the inception, drafting, and final approval of the manuscript.

Declaration of financial/other relationships

H.F.B., B.C.D., and S.H. have disclosed that they have received consultancy fees from Pfizer.

CMRO peer reviewers on this manuscript have no relevant financial relationships to disclose.

Acknowledgments

Medical writing support was provided by Diane M. Sloan PharmD of Peloton Advantage LLC, and was funded by Pfizer.

Notes

*Gaviscon is a registered trade name of Reckitt Benckiser Healthcare France, Massy Cedex, France