Boardman Helen F, Delaney Brendan C, Haag Sebastian
University of Nottingham, School of Pharmacy , Nottingham , UK.
Curr Med Res Opin. 2015;31(7):1309-18. doi: 10.1185/03007995.2015.1047745. Epub 2015 Jun 15.
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.
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.
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.
Implementation of a simple algorithm will empower pharmacists and consumers alike and ensure consistent and appropriate care.
单纯性烧心和胃酸反流越来越多地使用非处方药物进行治疗和管理。然而，随着抗酸剂、藻酸盐、组胺2受体拮抗剂（H2RAs）和质子泵抑制剂（PPIs）可在柜台购买，消费者需要有关合适选择及其使用方法的指导。
通过对PubMed/Medline和谷歌学术进行文献检索，以及对已识别论文进行交叉引用，确定了相关指南、研究和综述。
抗酸剂、藻酸盐和H2RAs最适合偶尔出现的烧心症状，可在刺激性餐前或其他诱因之前服用，或在症状出现时按需服用。非处方PPI适用于药房中常见的各种症状严重程度/频率范围，但可能特别适合治疗频繁和/或非常烦人的烧心患者。每日服用PPI的2至4周疗程可使频繁烧心症状完全缓解。咨询很重要，以确保患者明白，服用PPI时症状未缓解或症状迅速复发表明需要咨询医生，而数月后症状复发可能表明需要再次进行疗程治疗。在非处方环境中，有效沟通和确保正确用药的必要性使得药剂师在很大程度上承担了烧心和胃酸反流管理的责任。本文提出了一种算法，详细说明了何时以及如何使用现有的非处方药物。该算法还突出了应直接转诊给医生的、表明存在其他潜在疾病的警示特征和非典型症状。
实施一种简单的算法将使药剂师和消费者都能从中受益，并确保提供一致且适当的护理。
