Jeannette Y. Wick, RPh, MBA, FASCP
Acid reflux is an extremely common problem, and pharmacists can play an important role in guiding patients to the appropriate OTC treatments for it.
Almost everyone experiences heartburn occasionally; at any one time, up to 20% of the population is affected. Specific foods such as green peppers, citrus, coffee, and garlic can cause a burning sensation, a sour taste that repeats with every belch, or the feeling that food is regurgitating. Heavy drinking can induce these symptoms as well, and several conditions can trigger heartburn in young people. In addition, pregnancy is a likely cause in young women. Some people are simply genetically predisposed to acid reflux, more formally defined as the sensation of retrosternal burning radiating toward the neck as stomach acid works its way into the esophagus. With increasing age, heartburn and other acid reflux disease incidences grow. Often, medication causes or contributes to this problem, so when patients consult a pharmacist for help, they are more likely to identify root causes and find better management strategies than when they self-medicate without input.
Products like Alka-Seltzer (effervescent sodium bicarbonate, potassium bicarbonate, and anhydrous citric acid) and Pepto-Bismol, popular in the 1960s, are still known for their vintage advertising campaigns. These products remain medicine cabinet staples in many homes, and are still effective for fast, symptomatic relief of ordinary heartburn and indigestion. Treatment has changed remarkably in the decades since, however, and today we have even better approaches for patients who experience acid reflux after eating certain foods. In the late 1970s, several new products were introduced to help patients with any condition on the acid reflux disease continuum. These products didn’t replace the stomach remedy liquids Americans had come to rely on, but offered more effective alternatives for chronic, persistent, or severe acid reflux. H2
-receptor antagonists entered the market with the 1977 approval of cimetidine as a prescription drug. Today, they are available as OTC products and widely used. In 1989, the FDA approved omeprazole, the first proton pump inhibitor (PPI). It, too, is now available as an OTC product. By 2009, proton pump inhibitors followed only antipsychotics and lipid regulators in terms of annual sales volume.
-receptor antagonists, and proton pump inhibitors are the treatment cornerstones for acid reflux. They are available as oral products, intravenous injects, and combination products. Few pharmacists can work a full day without encountering a prescription for or a patient’s questions about acid reflux. It’s imperative for pharmacists to realize that all of these drugs have a niche carved out by the drug’s onset (with antacids being the fastest), cost-effectiveness, and ability to relieve symptoms (with PPIs rated best, although they still fail to relieve symptoms for about a fourth of patients).
Patients who have been exposed to direct-to-consumer advertising or spent time exploring the Internet for information on treating their acid reflux often describe their problems using medical vocabulary, rather than what they feel in terms of the nature, onset, duration, and symptom severity. They may also have questions about information they have learned from the media about newly discovered side effects or drug interactions. They may want to self-treat, but patients experiencing serious symptoms such as difficulty swallowing, pain when eating, chest pain, unexplained weight loss, or continual nausea, vomiting, or diarrhea may need to see a physician or physician extender. Pharmacists who question patients about their symptoms using simple language are likely to gather more and better information than those who accept patients’ use of medical jargon without making an effort to clarify it.
The Pharmacy Times
Acid Reflux Condition Center will deal with acid reflux in all its permutations:
simple and occasional regurgitation of acid or tasteless, clear liquid (water brash)
frequent heartburn and dyspepsia
chronic gastroesophageal reflux disease (GERD)
extraesophageal reflux disease
We’ll post information about the latest studies and findings on acid reflux so you can provide up-to-date information on lifestyle modifications, treatments, and concerns to patients.
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Acid Reflux Condition Center, check out our other inaugural posts:
Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.