Evidence-based treatment of frequent heartburn: the benefits and limitations of over-the-counter medications.
OBJECTIVE
This review summarizes the pharmacological effects of over-the-counter (OTC) heartburn drugs, and the implications for treating frequent heartburn.


METHODS
PubMed and SCOPUS were searched across all years to identify well-controlled, randomized clinical studies that assessed mechanism of action and efficacy.


CONCLUSIONS
Antacids can transiently neutralize acid in the esophagus, but do not significantly affect gastric pH or prevent subsequent heartburn episodes. Histamine-2 receptor antagonists (H2 RAs) rapidly develop tolerance with repeat dosing, and exhibit an analgesic effect that may provide heartburn relief while leaving the esophagus exposed to acid. Proton pump inhibitors (PPIs) provide a sustained inhibition of gastric acid production, and are superior to antacids and H2 RAs for control of gastric acid and treatment of frequent heartburn.


CONCLUSIONS
When recommending therapies for frequent heartburn, it is of particular importance to understand the strengths and weaknesses of available OTC medications. Antacids and H2 RAs are not recommended for treatment of frequent heartburn, while OTC PPIs are both indicated for, and effective for, treatment of frequent heartburn. A PPI dose of 20 mg is optimal for empiric treatment of frequent heartburn, and consistent with the 2013 treatment guidelines established by the American College of Gastroenterology (ACG) for treatment with a minimum effective dose.
Procter & Gamble, Mason, Ohio.
Johnson W
JW
McRorie
Roger D
RD
Gibb
Philip B
PB
Miner
D000863:Antacids / Q000494:pharmacology / Q000627:therapeutic use; D055317:Evidence-Based Practice / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000188:drug therapy; D006356:Heartburn / Q000188:drug therapy*; D006635:Histamine H2 Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D004366:Nonprescription Drugs / Q000009:adverse effects / Q000627:therapeutic use*
D000863:Antacids; D006635:Histamine H2 Antagonists; D004366:Nonprescription Drugs
Gastroesophogeal reflux disease (GERD); pharmacology; rational prescribing; review