Gastroenterology Express Report

Publication date: 2004-06-10

Comparing Treatment Options for the Rapid Relief of Symptomatic and Episodic Heartburn

This report was reviewed for medical and scientific accuracy by Diana Vamos, PharmD, Clinical Oncology Pharmacist, The Cancer Institute of New Jersey,New Brunswick, New Jersey

Expert Commentary

John R. Horn, PharmD, FCCP, Professor of Pharmacy, University of Washington School of Pharmacy and Associate Director of the University of Washington Medical Center Pharmacy Services, Seattle, Washington

According to the results of a recent study, subjects treated with the combination of famotidine 10 mg/calcium carbonate 800 mg/magnesium hydroxide 165 mg (Pepcid Complete) reached a gastric pH ≥3.0 and pH ≥4.0 significantly faster than subjects treated with omeprazole 20 mg (Prilosec OTC) or placebo.¹ These results suggest the combination of famotidine/calcium carbonate/magnesium hydroxide will provide significantly faster relief than omeprazole 20 mg for symptomatic and episodic heartburn associated with gastro-esophageal reflux disease (GERD). Moreover, the combined use of an antacid and famotidine provides the dual benefit of a rapid onset of heartburn relief with a prolonged duration of heartburn relief. The delayed onset of acid suppression and symptom relief noted with omeprazole makes it a less desirable choice for most patients. These results complement recent recommendations from an American Gastroenterological Association Consensus Development Panel on the use of famotidine/calcium carbonate/ magnesium hydroxide in the treatment of episodic heartburn.²

Heartburn is a predominant and frequent symptom of GERD. Heartburn is routinely encountered by pharmacists since GERD is one of the most common chronic disorders of the gastrointestinal tract,³ producing intermittent symptoms. In its milder manifestation, the heartburn associated with GERD is typically transient. However, in some individuals, the heartburn is severe and typically is accompanied by prolonged episodes of reflux, particularly at night. Symptoms concurrent with heartburn may include regurgitation of gastric contents, nocturnal wheezing, coughing, hoarseness, and with disease that is more advanced, dysphagia or bleeding. Thus, for most patients with heartburn, treatment should provide rapid symptom relief and protection from recurrence.

A systematic review of population studies of GERD symptoms (eg, heartburn) indicated a prevalence range between 10% and 48%.⁴ The socioeconomic impact of GERD is substantial given that 61 million adults in the United States experience heartburn at least once a month and 18 million individuals take some form of medication for indigestion at least twice weekly,⁵ resulting in estimated annual direct costs of $9.3 billion.⁶

Pharmacists are often the first healthcare providers consulted by patients who are experiencing heartburn. Upon appropriate and thorough questioning of the patient to ascertain duration and severity of symptoms, pharmacists can be instrumental in helping patients with heartburn successfully self-manage their condition with a variety of safe and effective over-the-counter (OTC) medications. Furthermore, pharmacists can qualify the patient for possible referral to their primary care physician for treatment.

The purpose of this Gastroenterology Express Report^TM is to review the data recently presented on the combination of famotidine/calcium carbonate/magnesium hydroxide, as well as alternative treatment options for the treatment of symptomatic and episodic heartburn. By combining appropriate patient evaluation and counseling together with rational OTC product selection, pharmacists will be able to effectively manage many patients with symptomatic and episodic heartburn.

Treatment Options for Heartburn Associated with Gastroesophageal Reflux Disease

Lifestyle Modifications
Simple life-style modifications should be emphasized and incorporated into all stages of GERD treatment.⁷ Such modifications include sleeping with the head of the b