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Curr Med Res Opin. 2015;31(7):1309-18. doi: 10.1185/03007995.2015.1047745. Epub 2015 Jun 15.

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

Author information

1
University of Nottingham, School of Pharmacy , Nottingham , UK.

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

PMID:
25950642
DOI:
10.1185/03007995.2015.1047745
[Indexed for MEDLINE]

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