Short- and long-term management of heartburn and other acid-related disorders: development of an algorithm for primary care providers
Fennerty, M.B.; Finke, K.B.; Kushner, P.R.; Peura, D.A.; Record, L.; Riley, L.; Ruoff, G.E.; Simonson, W.; Wright, W.L.
Journal of Family Practice 58(7 Suppl Short): S1-12
2009
ISSN/ISBN: 1533-7294 PMID: 19825313 Document Number: 14914
No published guidelines are currently available for the treatment of heartburn, except when it is a symptom of GERD. Consequently, a Heartburn Algorithm Development Workgroup comprised of 9 experts convened to develop algorithms for short- and long-term management of heartburn. Prior to considering treatment for heartburn, health care providers must first consider whether cardiac, alarm, or extraesophageal symptoms are present because these require additional diagnostic testing, immediate management, and/or referral to an appropriate specialist. Additionally, lifestyle modifications should be discussed with patients, even though the benefits are modest at best. Episodic heartburn should be treated with antacids or H2RAs, whereas predictable meal-provoked heartburn should be treated with H2RAs, either alone or in combination. Frequent heartburn should initially be treated with a 14-day course of a nonprescription or a prescribed PPI, with reassessment and decisions regarding further treatment or referral at the end of that period. Symptom recurrence requires additional treatment at a dose and frequency sufficient to control symptoms. For long-term treatment of symptomatic acid-related disorders, PPIs are superior to antacids or H2RAs. Notably, the lowest effective dose of the selected treatment is most appropriate for the management of acid-related GI symptoms. Therefore, when symptoms are well-controlled with a prescription product, health care providers should consider switching the patient to a lower dose or to a nonprescription product, but they should be prepared to further evaluate the patient or resume the original prescription if symptoms recur. For erosive esophagitis and NSAID prophylaxis, long-term daily PPI therapy is required. In these cases, nonprescription medication can be used if the dosage is appropriate. In conclusion, the algorithms developed by this workgroup provide guidance and effective treatment options for optimal management of heartburn symptoms and other acidrelated disorders associated with heartburn in the clinical setting.
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