Evidence-based treatment of frequent heartburn: The benefits and limitations of over-the-counter medications

McRorie, Johnson W.; Gibb, Roger; Miner, Philip B.

doi:10.1002/2327-6924.12133

Cited by 9 publications

(5 citation statements)

References 47 publications

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“…PPIs offer the most effective and long‐lasting acid suppression compared with other medications (Badillo and Francis ; McRorie et al. ) and are well tolerated, making them the treatment of choice for heartburn (Attwood et al. ).…”

Section: Introductionmentioning

confidence: 99%

“…Antacids, histamine-2 receptor antagonists (H2RAs), and proton pump inhibitors (PPIs) increase intragastric pH to varying degrees through different mechanisms (Hunt 1999). PPIs offer the most effective and long-lasting acid suppression compared with other medications (Badillo and Francis 2014;McRorie et al 2014) and are well tolerated, making them the treatment of choice for heartburn (Attwood et al 2015). PPIs are weak bases that accumulate selectively in the acidic space of the secretory canaliculus of stimulated parietal cells.…”

Section: Introductionmentioning

confidence: 99%

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A randomized, crossover pharmacodynamic study of immediate‐release omeprazole/sodium bicarbonate and delayed‐release lansoprazole in healthy adult volunteers

Pratha

McGraw

Tobin³

2016

Pharmacology Res & Perspec

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Proton pump inhibitors (PPIs) effectively block gastric acid secretion and are the treatment of choice for heartburn. PPIs differ, however, in onset of action and bioavailability. In this single‐center, open‐label, three‐way crossover study, onset of action of immediate‐release omeprazole 20 mg/sodium bicarbonate 1100 mg (IR‐OME) and delayed‐release (DR) lansoprazole 15 mg was evaluated in 63 healthy fasting adults. Subjects were randomized to once daily IR‐OME, or DR‐lansoprazole, or no treatment for 7 days. The primary efficacy endpoint was the earliest time where a statistically significant difference was observed between IR‐OME and DR‐lansoprazole in median intragastric pH scores for three consecutive 5‐min intervals on day 7. Secondary endpoints compared effects of active treatments on days 1 and 7 (e.g., time to sustained inhibition, percentage of time with pH >4). A significant difference in median intragastric pH favoring IR‐OME was observed on day 7 starting at the 10‐ to 15‐min interval postdosing (P = 0.024) and sustaining through the 115‐ to 120‐min interval (P = 0.017). On day 1, IR‐OME achieved sustained inhibition of intragastric acidity significantly faster than DR‐lansoprazole. IR‐OME maintained pH >4 significantly longer than DR‐lansoprazole over a 24‐h period (P = 0.007) on day 7. Overall, results of this study demonstrate IR‐OME is safe and well tolerated and that treatment with IR‐OME results in significantly faster onset of action and better gastric acid suppression at steady state than DR‐lansoprazole.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A randomized, crossover pharmacodynamic study of immediate‐release omeprazole/sodium bicarbonate and delayed‐release lansoprazole in healthy adult volunteers

Pratha

McGraw

Tobin³

2016

Pharmacology Res & Perspec

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“…Symptomatic gastro-oesophageal reflux is treated with agents that counter the direct effects of the acid reflux on the oesophageal mucosa and/or medications that target gastric acid production associated with reflux, with different agents being more appropriate depending on the varying severity and frequency of episodes [ 4 , 7 , 17 ]. The initial recommendation for management is diet and lifestyle changes, such as weight loss and avoidance of foods or other substances that may trigger reflux [ 7 , 11 ].…”

Section: Resultsmentioning

confidence: 99%

The role of the pharmacist in the selection and use of over-the-counter proton-pump inhibitors

Boardman

Heeley

2015

Int J Clin Pharm

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Background Heartburn and other symptoms of gastro-oesophageal reflux occur in ~30 % of survey respondents in multiple countries worldwide. Heartburn and acid regurgitation are common complaints in the pharmacy, where patients frequently seek relief through medication and advice. The growing number of proton-pump inhibitors available in the over-the-counter setting provides an efficacious choice to patients experiencing frequent heartburn. Pharmacists can assist patients in their treatment decisions whilst inquiring about alarm symptoms that should prompt a physician referral. Aim of the review Provide pharmacists with a review of current clinical research and expert guidelines on use of over-the-counter proton-pump inhibitors. Methods This narrative review was conducted to identify publications relevant to the following themes: overview of available treatments for frequent episodes of heartburn/acid regurgitation; treatment algorithms providing guidance on when to use over-the-counter proton-pump inhibitors; and the role of the pharmacist in the use of over-the-counter proton-pump inhibitors. Results Frequent symptoms of acid reflux, such as heartburn and acid regurgitation, can interfere substantially with daily life activities. Proton-pump inhibitors are the most efficacious treatment for frequent reflux symptoms and are recommended as an appropriate initial treatment in uncomplicated cases. Proton-pump inhibitors have varying pharmacokinetics and pharmacodynamics across the class; 20 mg esomeprazole has higher bioavailability and exposure than over-the-counter omeprazole, for example. However, differences in clinical efficacy for symptom relief have not been demonstrated. The safety and tolerability of proton-pump inhibitors have been well established in clinical trial and post-marketing settings, and use of a short regimen is associated with a very low likelihood of missing a more serious condition. Pharmacists can assist patients with accurate self-diagnosis by asking short, simple questions to characterize the nature, severity, and frequency of symptoms. Additionally, pharmacists can inquire about alarm symptoms that should prompt referral to a physician. Pharmacists should inform those patients for whom over-the-counter proton-pump inhibitors are appropriate on their proper use. Conclusion Over-the-counter proton-pump inhibitors have a valuable role in the treatment of frequent heartburn. Pharmacists have the opportunity to guide patients through selection of the best treatment option for their symptoms.

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“…While antacids can provide prompt and effective relief of heartburn, the effect is often short-lived. The lack of gastric acid neutralization allows repeated exposure of acidic contents to the esophagus with each subsequent reflux episode and leads to recurrent heartburn symptoms [17]. Despite their widespread use, scientific evidence supporting the use of antacids to treat GERD remains limited.…”

Section: Antacidsmentioning

confidence: 99%

“…Antacids have been available over‐the‐counter for many years and remain frequently used to treat symptomatic GERD, despite the introduction of acid‐suppressing medications [17]. Antacids comprise a group of inorganic, relatively insoluble salts of aluminum, calcium, magnesium, or sodium [18].…”

Section: Pharmacologic Therapymentioning

confidence: 99%

Medical Treatment of Gastroesophageal Reflux Disease

Kroch

Madanick

2017

World j. surg.

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Medical treatment is effective in the majority of patients with gastroesophageal reflux disease (GERD). Lifestyle modifications are often recommended for patients with GERD, although the data supporting lifestyle recommendations are limited. Antacids are often used to treat the symptoms of GERD, but their effect is short-lived. H2-receptor antagonists and proton-pump inhibitors provide more effective options for remission of GERD symptoms and healing of esophagitis. Prokinetic medications (e.g., metoclopramide) have not been proven to help in the control of symptoms. Baclofen, which inhibits transient lower esophageal sphincter relaxations, provide an additional option for patients with persistent symptoms related to GERD; however its use is limited by side effects. Long-term medical therapy for GERD should be tailored to each patient to provide symptomatic control and maintain esophageal mucosal healing.

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Evidence-based treatment of frequent heartburn: The benefits and limitations of over-the-counter medications

Cited by 9 publications

References 47 publications

A randomized, crossover pharmacodynamic study of immediate‐release omeprazole/sodium bicarbonate and delayed‐release lansoprazole in healthy adult volunteers

A randomized, crossover pharmacodynamic study of immediate‐release omeprazole/sodium bicarbonate and delayed‐release lansoprazole in healthy adult volunteers

The role of the pharmacist in the selection and use of over-the-counter proton-pump inhibitors

Medical Treatment of Gastroesophageal Reflux Disease

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