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Type: Journal article
Title: Management of reflux symptoms with over-the-counter proton pump inhibitors: Issues and proposed guidelines
Author: Haag, S.
Andrews, J.
Katelaris, P.
Gapasin, J.
Galmiche, J.
Hunt, R.
Layer, P.
Malfertheiner, P.
Holtmann, G.
Citation: Digestion: international journal of gastroenterology, 2009; 80(4):226-234
Publisher: Karger
Issue Date: 2009
ISSN: 0012-2823
Statement of
Sebastian Haag, Jane M. Andrews, Peter H. Katelaris, Judith Gapasin, Jean Paul Galmiche, Richard Hunt, Peter Layer, Peter Malfertheiner and Gerald Holtmann
Abstract: 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 histamine2 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.
Keywords: Proton pump inhibitors
Gastroesophageal reflux disease
Over-the-counter therapy
Histamine₂ receptor antagonist
Description: This article is based on a workshop that was held in Cairo, Egypt, November 20–22, 2008, and includes papers and guidelines published until February 2009. The meeting was supported by an unrestricted grant from Nycomed. Published online: October 16, 2009
Rights: © 2009 S. Karger AG, Basel
DOI: 10.1159/000235953
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