Digestive Health Express Report

Data presented at a Symposium held during the American Pharmaceutical Association (APhA) Annual Meeting & Exposition New Orleans, Louisiana

Publication date: 2003-05-19

Evidence-Based Strategies for the Prevention and Treatment of Heartburn

This report was reviewed for medical and scientific accuracy by Evelyn R. Hermes De Santis, PharmD, Clinical Associate Professor, Department of Pharmacy Practice and Administration, Rutgers, The State University of New Jersey, Ernest Mario School of Pharmacy, Piscataway, New Jersey

Editorial

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

Heartburn, the predominant symptom of gastroesophageal reflux disease (GERD), is one of the most common conditions encountered by pharmacists. GERD is a chronic disease that produces intermittent symptoms. Pharmacists are likely to be 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. Moreover, pharmacists can qualify the patient for possible referral to their primary care physician for treatment. The availability of these medications enhances consumers' access to efficacious treatment options, empowers patients to improve self-care, and in the era of managed care and fiscal constraint, may possibly reduce health care expenditures. However, the multitude of available OTC products, combined with differing mechanisms of action, can create confusion among consumers and healthcare providers alike. What is the most effective treatment for heartburn? How long should the product be used before determining whether alternative treatment is needed? At what dose is this product most effective? Should the dose be increased? When should you take the product? How do you treat breakthrough episodes? At what point should the patient see their physician? In this context, the pharmacist is challenged to individualize appropriate patient therapy through understanding of the advantages and disadvantages of each of the multiple treatment options.

The availability of OTC therapies including antacids, H₂ receptor antagonists (H₂RAs), and the combined use of these agents, provides a seemingly endless number of treatment options. However, most pharmacists will select a few products to recommend based on the patient's presentation. Since antacids have the most rapid onset of action, they are most appropriate for the treatment of active heartburn. A chewed antacid tablet would seem to provide an optimal drug delivery method to neutralize esophageal acid and terminate the heartburn resulting from acid refluxing into the esophagus. H₂RAs have the advantages of suppressing gastric acid production, producing a longer duration of action than an antacid, and are preferred for heartburn prophylaxis and the control of nocturnal heartburn. I believe all patients should be provided with both an antacid and a H₂RA, either in combination or as separate products, and given instructions on how to use the product to treat their symptoms. The combined use of an antacid and H₂RA provides the dual benefit of a rapid onset of heartburn relief with a prolonged duration of heartburn prevention. By combining appropriate patient evaluation and counseling together with rational OTC product selection, pharmacists will be able to effectively manage many patients with uncomplicated heartburn.

At the recent 2003 American Pharmaceutical Association Annual (APhA) Meeting & Exposition, data was presented on currently available and future OTC treatment options for heartburn associated with GERD. The purpose of this Express Report is to review and summarize this data from the pharmacist's perspective in order to prepare and assist the pharmacist in recommending effective pharmacologic therapies for his/her patients with heartburn.

Heartburn Pers