Armstrong David, Nakhla Nardine
Division of Gastroenterology, McMaster University . Hamilton, Ontario ( Canada ).
School of Pharmacy, University of Waterloo . Kitchener, Ontario ( Canada ).
Pharm Pract (Granada). 2016 Oct-Dec;14(4):868. doi: 10.18549/PharmPract.2016.04.868. Epub 2016 Dec 15.
Heartburn and acid regurgitation are the cardinal symptoms of gastroesophageal reflux and occur commonly in the Canadian population. Multiple non-prescription treatment options are available for managing these symptoms, including antacids, alginates, histamine-H2 receptor antagonists (H2RAs), and proton-pump inhibitors (PPIs). As a result, pharmacists are ideally positioned to recommend appropriate treatment options based upon an individual's needs and presenting symptoms, prior treatment response, comorbid medical conditions, and other relevant factors. Individuals who experience mild heartburn and/or have symptoms that occur predictably in response to known precipitating factors can manage their symptoms by avoiding known triggers and using on-demand antacids and/or alginates or lower-dose non-prescription H2RAs (e.g. ranitidine 150 mg). For those with moderate symptoms, lifestyle changes, in conjunction with higher-dose non-prescription H2RAs, may be effective. However, for individuals with moderate-to-severe symptoms that occur frequently (i.e. ≥2 days/week), the non-prescription (Schedule II) PPI omeprazole 20 mg should be considered. The pharmacist can provide important support by inquiring about the frequency and severity of symptoms, identifying an appropriate treatment option, and recognizing other potential causes of symptoms, as well as alarm features and atypical symptoms that would necessitate referral to a physician. After recommending an appropriate treatment, the pharmacist can provide instructions for its correct use. Additionally, the pharmacist should inquire about recurrences, respond to questions about adverse events, provide monitoring parameters, and counsel on when referral to a physician is warranted. Pharmacists are an essential resource for individuals experiencing heartburn; they play a crucial role in helping individuals make informed self-care decisions and educating them to ensure that therapy is used in an optimal, safe, and effective manner.
烧心和胃酸反流是胃食管反流的主要症状，在加拿大人群中很常见。有多种非处方治疗方案可用于管理这些症状，包括抗酸剂、藻酸盐、组胺H2受体拮抗剂（H2RAs）和质子泵抑制剂（PPIs）。因此，药剂师非常适合根据个人需求、当前症状、既往治疗反应、合并症以及其他相关因素推荐合适的治疗方案。经历轻度烧心和/或症状可因已知诱发因素而可预测地出现的个体，可以通过避免已知诱因并使用按需抗酸剂和/或藻酸盐或低剂量非处方H2RAs（如雷尼替丁150毫克）来管理症状。对于症状中度的患者，改变生活方式并结合高剂量非处方H2RAs可能有效。然而，对于经常出现中度至重度症状（即≥每周2天）的个体，应考虑使用非处方（附表II）PPI奥美拉唑20毫克。药剂师可以通过询问症状的频率和严重程度、确定合适的治疗方案、识别症状的其他潜在原因以及需要转诊给医生的警示特征和非典型症状来提供重要支持。在推荐合适的治疗方法后，药剂师可以提供正确使用方法的指导。此外，药剂师应询问复发情况、回答有关不良事件的问题、提供监测参数，并就何时需要转诊给医生提供咨询。药剂师是烧心患者的重要资源；他们在帮助患者做出明智的自我护理决策以及教育患者确保以最佳、安全和有效的方式使用治疗方法方面发挥着关键作用。
