title: Partnership in optimizing management of reflux symptoms: a treatment algorithm for over-the-counter proton-pump inhibitors.
abstract: BACKGROUND
  Uncomplicated heartburn and acid regurgitation are increasingly treated and managed using over-the-counter medications. However, with over-the-counter availability of antacids, alginates, histamine 2 receptor antagonists (H2RAs), and proton-pump inhibitors (PPIs), consumers need guidance as to appropriate options and how to use them.
  
  
  METHODS
  Relevant guidelines, studies, and reviews were identified via literature searches of PubMed/Medline and Google Scholar, as well as cross-referencing from the identified papers.
  
  
  RESULTS
  Antacids, alginates, and H2RAs are best suited to management of occasional heartburn, taken either before provocative meals or other triggers or on demand when symptoms arise. Over-the-counter PPIs are appropriate options across the range of symptom severity/frequency typically encountered in the pharmacy, but may be particularly appropriate for treatment of those with frequent and/or very bothersome heartburn. A 2-4 week course of daily PPIs can lead to complete resolution of frequent heartburn. Counseling is important to ensure that patients understand that failure of symptoms to resolve or a rapid return of symptoms while taking a PPI is an indication to consult a doctor, whereas a return of symptoms after a period of months may be an indication for just another course of treatment. The need for effective communication and for ensuring use of the correct medication in the over-the-counter setting puts much of the responsibility for management of heartburn and acid regurgitation on the pharmacist. A proposed algorithm that details when and how to use available over-the-counter medications is presented. This algorithm also highlights alarm features and atypical symptoms indicative of other underlying conditions that should be referred directly to a physician.
  
  
  CONCLUSIONS
  Implementation of a simple algorithm will empower pharmacists and consumers alike and ensure consistent and appropriate care.
authors.affiliation: University of Nottingham, School of Pharmacy , Nottingham , UK.
authors.forename: Helen F
authors.initials: HF
authors.lastname: Boardman
authors.forename: Brendan C
authors.initials: BC
authors.lastname: Delaney
authors.forename: Sebastian
authors.initials: S
authors.lastname: Haag
mesh_terms: D000465:Algorithms; D000863:Antacids / Q000627:therapeutic use; D005764:Gastroesophageal Reflux / Q000188:drug therapy*; D006356:Heartburn / Q000188:drug therapy*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D004366:Nonprescription Drugs / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*
chemical_list: D000863:Antacids; D006635:Histamine H2 Antagonists; D004366:Nonprescription Drugs; D054328:Proton Pump Inhibitors
keywords: Alginates; Antacids; Gastroesophageal reflux; Heartburn; Histamine 2 receptor antagonist; Proton-pump inhibitors