Many people experience the discomfort associated with dyspepsia and heartburn at some point, but others unfortunately experience gastric discomfort on a regular basis.

Dyspepsia and heartburn are common complaints that if left unresolved can negatively affect quality of life, interrupt sleep, and restrict or limit the ingestion of certain foods.1,2 Patients may experience both dyspepsia and heartburn.

An estimated 60 million individuals in the United States experience heartburn at least once a month, and more than 15 million experience it daily, according to the American College of Gastroenterology.3

The upper gastrointestinal (GI) tract consists of the duodenum, esophagus, and stomach, and there are numerous causes for upper gastric pain.4,5 Some sources are minor and amenable to self-treatment, but others may necessitate further and immediate medical treatment. Examples of possible causes of upper gastric pain include appendicitis, bowel obstruction, diverticulitis, dyspepsia, flatulence, gallstones, gastritis, gastroenteritis, heart burn, liver or pancreatic issues, and muscle pain.4,6 In many cases, a condition may cause another complication, and it is critical to recognize when to pursue further medical care and evaluation.4,6 For example, gallstones can cause liver dysfunction, and ulcers can cause indigestion.2,4 Depending upon the severity and types of symptoms, upper gastric pain can be a minor inconvenience or so intense that it makes functioning difficult.

Because pharmacists are likely to encounter patients seeking guidance on nonprescription products to prevent and treat mild or moderate cases of dyspepsia and heartburn, they should be prepared to counsel patients about the efficacy and safety of these products. Available OTC products to treat dyspepsia, gastroesophageal reflux disease (GERD), and heartburn include antacids and histamine2-receptor agonists (H2RAs) for patients with infrequent, mild dyspepsia and heartburn. There are also proton pump inhibitors that can be used for treating frequent heartburn (occurring more than 2 days per week) or for those who do not respond to OTC H2RAs.2

Before recommending any nonprescription product for dyspepsia and heartburn, a pharmacist should determine whether self-treatment is appropriate. Pharmacists can identify patients at increased risk for developing dyspepsia and heartburn, due to certain lifestyle habits, medical conditions, or pharmacological agents, as well as direct patients with symptoms not amenable to self-treatment to immediately seek further medical evaluation. During counseling, patients should be advised that heartburn that is frequent, persistent, or lasts longer than 3 months is the most common symptoms of GERD, which can cause long-term complications, such as Barrett’s esophagus, esophageal cancer, esophagitis, and GI bleeding, if left untreated.7

Chronic heartburn may increase an individual’s risk of throat cancer, according to the American Cancer Society. Therefore, it is important that individuals with frequent heartburn receive appropriate treatment as soon as possible.8

Patients with dyspepsia and heartburn may present with a bitter or sour taste in the mouth; choking or coughing, especially while lying down; excessive burping; frequent sleep interruptions caused by indigestion; a hoarse, sore throat; painful burning sensation in the chest, just behind the sternum, characteristically within 1 to 4 hours after eating; and regurgitation of food.5 Several factors are often considered when selecting a nonprescription agent for the self-treatment of dyspepsia and heartburn, such as contraindications; cost; dosage form and intervals; duration, frequency, and severity of symptoms; and potential drug/drug interactions. Pediatric patients, those with preexisting medical conditions, and women who are lactating or pregnant should consult with their primary care physicians (PCPs) before using any of these products. Patients with persistent and recurring episodes of heartburn or those exhibiting atypical or severe symptoms should be immediately referred to their PCPs for additional medical evaluation. If symptoms show no signs of improvement or worsen after 14 days of self-treatment, patients using OTC products should seek immediate medical care from their PCPs.

Pharmacists also can recommend nonpharmacological strategies for averting or diminishing the prevalence of dyspepsia and heartburn, such as avoiding greasy or spicy foods or late-night eating, consuming larger meals, losing weight, and stopping smoking.

An excellent patient resource on GERD is the American Gastroenterology Association (AGA) website (https://patients.gi.org/topics/acid-reflux/). The AGA also has an online test for GERD on its website (https://gi.org/topics/acidreflux/). 
 
Yvette C. Terrie, BSPharm, RPh, is a consulting pharmacist and a medical writer in Haymarket, Virginia.


REFERENCES
  1. What is GERD. American Gastroenterological Association. Accessed September 4, 2020. https:// gastro.org/practice-guidance/gi-patient-center/topic/gastroesophageal-reflux-disease-gerd/
  2. Whetsel T, Zweber A. Heartburn and dyspepsia. In: Krinsky D, Berardi R, Ferreri S, et al, eds. Handbook of Nonprescription Drugs. 19th ed. Washington, DC: American Pharmacists Association; 2018.
  3. Moayyedi P, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. ACG and CAG clinical guideline: management of dyspepsia. Am J Gastroenterol. 2017;112(7):988-1013. doi:10.1038/ajg.2017.154
  4. Kapoor VK. Upper GI tract anatomy. Medscape. Updated June 28, 2016. Accessed September 8, 2020. https://emedicine.medscape.com/article/1899389-overview
  5. Villines Z. What causes upper stomach pain? Medical News Today. February 28, 2019. Accessed September 8, 2020. https://www.medicalnewstoday.com/articles/324591.php
  6. Davis CP. Abdominal pain causes. Medicine Net. Accessed September 8, 2020. https://www.medicinenet.com/abdominal_pain_causes/views.htm
  7. MacGill M. What is acid reflux? Medical News Today. November 13, 2017. Accessed September 8, 2020. https://www.medicalnewstoday.com/articles/146619.php
  8. Can esophageal cancer be prevented? American Cancer Society. Updated June 9, 2020. Accessed September 8, 2020. https://www.cancer.org/cancer/esophagus-cancer/causes-risks-prevention/prevention.html