title: The role of the pharmacist in the selection and use of over-the-counter proton-pump inhibitors.
abstract: BACKGROUND
  Heartburn and other symptoms of gastro-oesophageal reflux occur in ~30% of survey respondents in multiple countries worldwide. Heartburn and acid regurgitation are common complaints in the pharmacy, where patients frequently seek relief through medication and advice. The growing number of proton-pump inhibitors available in the over-the-counter setting provides an efficacious choice to patients experiencing frequent heartburn. Pharmacists can assist patients in their treatment decisions whilst inquiring about alarm symptoms that should prompt a physician referral. Aim of the review Provide pharmacists with a review of current clinical research and expert guidelines on use of over-the-counter proton-pump inhibitors.
  
  
  METHODS
  This narrative review was conducted to identify publications relevant to the following themes: overview of available treatments for frequent episodes of heartburn/acid regurgitation; treatment algorithms providing guidance on when to use over-the-counter proton-pump inhibitors; and the role of the pharmacist in the use of over-the-counter proton-pump inhibitors.
  
  
  RESULTS
  Frequent symptoms of acid reflux, such as heartburn and acid regurgitation, can interfere substantially with daily life activities. Proton-pump inhibitors are the most efficacious treatment for frequent reflux symptoms and are recommended as an appropriate initial treatment in uncomplicated cases. Proton-pump inhibitors have varying pharmacokinetics and pharmacodynamics across the class; 20 mg esomeprazole has higher bioavailability and exposure than over-the-counter omeprazole, for example. However, differences in clinical efficacy for symptom relief have not been demonstrated. The safety and tolerability of proton-pump inhibitors have been well established in clinical trial and post-marketing settings, and use of a short regimen is associated with a very low likelihood of missing a more serious condition. Pharmacists can assist patients with accurate self-diagnosis by asking short, simple questions to characterize the nature, severity, and frequency of symptoms. Additionally, pharmacists can inquire about alarm symptoms that should prompt referral to a physician. Pharmacists should inform those patients for whom over-the-counter proton-pump inhibitors are appropriate on their proper use.
  
  
  CONCLUSIONS
  Over-the-counter proton-pump inhibitors have a valuable role in the treatment of frequent heartburn. Pharmacists have the opportunity to guide patients through selection of the best treatment option for their symptoms.
authors.affiliation: School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK. helen.boardman@nottingham.ac.uk.
authors.forename: Helen F
authors.initials: HF
authors.lastname: Boardman
authors.affiliation: Lloydspharmacy, 113 Sneinton Road, Nottingham, NG2 4QL, UK.
authors.forename: Gordon
authors.initials: G
authors.lastname: Heeley
mesh_terms: D004347:Drug Interactions; D005764:Gastroesophageal Reflux / Q000188:drug therapy; D006801:Humans; D004366:Nonprescription Drugs / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D010595:Pharmacists; D024382:Professional Role; D054328:Proton Pump Inhibitors / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D004366:Nonprescription Drugs; D054328:Proton Pump Inhibitors
keywords: Counselling; Esomeprazole; Gastro-oesophageal reflux; Omeprazole; Over-the-counter therapy; Pharmacists; Proton-pump inhibitors