Contemporary understanding and management of reflux and constipation in the general population and pregnancy: a consensus meeting.
BACKGROUND
Gastro-oesophageal reflux disease (GERD) and constipation have a major impact on public health; however, the wide variety of treatment options presents difficulties for recommending therapy. Lack of definitive guidelines in pharmacy and general practice medicine further exacerbates the decision dilemma.


OBJECTIVE
To address these issues, a panel of experts discussed the principles and practice of treating GERD and constipation in the general population and in pregnancy, with the aim of developing respective treatment guidelines.


RESULTS
The panel recommended antacids 'on-demand' as the first-line over-the-counter treatment in reflux, and as rescue medication for immediate relief when reflux breaks through with proton pump inhibitors. Calcium/magnesium-based antacids were recommended as the treatment of choice for pregnant women because of their good safety profile. In constipation, current data do not distinguish a hierarchy between polyethylene glycol (PEG)-based laxatives and other first-line treatments, although limitations are associated with stimulant- and bulk-forming laxatives. Where data are available, PEG is superior to lactulose in terms of efficacy. In pregnancy, PEG-based laxatives meet the criteria for the ideal treatment.


CONCLUSIONS
The experts developed algorithms that present healthcare professionals with clear treatment options and management strategies for GERD and constipation in pharmacy and general practice medicine.
Tytgat
G N
GN
Academisch Medisch Centrum, Amsterdam, The Netherlands. g.n.tytgat@amc.uva.nl
Heading
R C
RC
Müller-Lissner
S
S
Kamm
M A
MA
Schölmerich
J
J
Berstad
A
A
Fried
M
M
Chaussade
S
S
Jewell
D
D
Briggs
A
A
D000328:Adult; D000368:Aged; D000465:Algorithms; D000863:Antacids / Q000627:therapeutic use; D002400:Cathartics / Q000627:therapeutic use; D002755:Choice Behavior; D003248:Constipation / Q000628:therapy*; D004032:Diet; D005260:Female; D005764:Gastroesophageal Reflux / Q000628:therapy*; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D004366:Nonprescription Drugs; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy
D000863:Antacids; D002400:Cathartics; D004366:Nonprescription Drugs