Role of the primary care provider in the diagnosis and management of heartburn.
BACKGROUND
Heartburn affects an estimated 42% of the US population. Often, patients are able to recognize symptoms and self-treat heartburn; however, patients with more persistent and/or troublesome symptoms should be evaluated by a physician or other healthcare provider.


METHODS
This review focuses on the role of the primary care provider in the diagnosis and treatment of heartburn.


METHODS
A search was conducted on PubMed (to November 2009) and articles relevant to the management of heartburn by a primary care provider topic were selected.


RESULTS
Diagnostic tools, such as endoscopy, and ambulatory pH monitoring, are recommended for advanced assessment of patients with frequent heartburn to avert misdiagnosis and to identify complications of reflux disease. Over-the-counter and prescription treatments for frequent heartburn symptoms include antacids, histamine(2)-receptor antagonists (H(2)RAs), antacid/H(2)RA combinations, and proton pump inhibitors (PPIs). Among these, PPIs represent the mainstay of acute and maintenance treatment regimens in reflux disorders and are more effective than H(2)RAs for long-term use due to the development of tolerance to the latter therapy. While once-daily PPI therapy may be sufficient in most patients, a few may require twice-daily PPI therapy to alleviate their symptoms. This review is limited by its relatively narrow focus on articles cited in PubMed.


CONCLUSIONS
The primary care provider is ideally situated to advise patients on the best treatment option for their condition and to provide follow-up care if required.
Kushner
Pamela R
PR
Department of Family Medicine, University of California at Irvine, Irvine, CA, USA. pamkushner@hotmail.com
D000863:Antacids / Q000627:therapeutic use; D003937:Diagnosis, Differential; D003938:Diagnostic Techniques, Digestive System; D005764:Gastroesophageal Reflux / Q000175:diagnosis; D006356:Heartburn / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D011320:Primary Health Care; D054328:Proton Pump Inhibitors / Q000627:therapeutic use
D000863:Antacids; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors