Self-management of reflux-like symptoms: A patient-centered decision-making approach

Background: Guidelines for the management of reflux-like symptoms (primarily heartburn and regurgitation) offer limited guidance to support decision-making in the nonprescription setting. This review aims to summarize and compare nonprescription treatment options within the context of reflux-like symptom pathophysiology and provide a practical evidence-based tool to help guide tailored treatment selection. Summary: A patient-centered approach should consider the requirement for reactive versus preventative therapies and each product’s unique characteristics. Antacids neutralize refluxed acid in the esophagus, providing temporary relief from occasional heartburn. Raft-forming alginate formulations provide relief of heartburn and regurgitation after meals by forming a viscous gel near the gastroesophageal junction, neutralizing the postprandial acid pocket and coating the esophagus when refluxed. Histamine-2 receptor antagonists reduce gastric acid secretion within 30 minutes, lasting for up to 12 hours, making them useful for treatment and prevention of heartburn, but tachyphylaxis is a limitation. Nonprescription proton pump inhibitors are most effective for preventing frequent acid-related symptoms. They are packaged as a 2-week course for daily use, achieving maximum effect after a few days. Key Messages: Important differences exist among self-management treatment options for reflux-like symptoms. A standardized algorithm is proposed to help tailor treatment selection according to symptom profile.