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

Helen F. Boardmana*, Brendan C. Delaneyb & Sebastian Haagca aUniversity of Nottingham, School of Pharmacy, Nottingham, UKb bDepartment of Primary Care and Public Health Sciences, King’s College London, London, UKc cGastro-Praxis Wiesbaden, Wiesbaden, GermanyAddress for correspondence: Helen Boardman PhD MRPharmS, Lecturer in Pharmacy Practice, University of Nottingham, School of Pharmacy, University Park, Nottingham, NG7 2RD, United Kingdom. Tel: +44 (0)115 951 4291; Fax: +44 (0)115 846 6249; helen.boardman@nottingham.ac.ukAbstractBackground: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.