Management of reflux symptoms with over-the-counter proton pump inhibitors: issues and proposed guidelines.
BACKGROUND
Symptoms of gastroesophageal reflux are widely prevalent. There is a continuum between subjects with mild reflux symptoms and those severely affected by gastroesophageal reflux disease (GERD). Both groups may at times access over-the-counter (OTC) therapies. For the purpose of this review, relevant papers, including national and international guidelines were reviewed and recommendations made for appropriate use of OTC proton pump inhibitor (PPI) therapy.


RESULTS
PPIs are the gold standard for treatment of reflux symptoms. OTC therapy with histamine(2) receptor antagonists (H2RAs) also plays a role. For the majority affected by reflux symptoms, effective symptom control is the most important outcome, as only a subgroup requires investigations or interventions. However, patients with alarm features (i.e. troublesome dysphagia, weight loss, predominant upper abdominal pain) are not recommended for OTC therapy and need prompt medical referral. Frequent relapses or failure to adequately respond to OTC therapy are additional triggers for medical assessment.


CONCLUSIONS
OTC treatment of typical reflux symptoms (acid regurgitation, heartburn) with antacids and H2RAs is now accepted as safe and results in short-term relief of symptoms. There is no evidence of additional risk with OTC PPIs compared to these existing OTC therapies and PPIs are significantly more efficacious.
Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany.
Sebastian
S
Haag
Jane M
JM
Andrews
Peter H
PH
Katelaris
Judith
J
Gapasin
Jean Paul
JP
Galmiche
Richard
R
Hunt
Peter
P
Layer
Peter
P
Malfertheiner
Gerald
G
Holtmann
D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D004366:Nonprescription Drugs / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012017:Referral and Consultation
D004366:Nonprescription Drugs; D054328:Proton Pump Inhibitors