Managing frequent heartburn in the pharmacy
Download the frequent heartburn consultation poster 
What is GORD?
Gastro-oesophageal reflux disease (GORD) is a chronic common condition in which gastric contents (including acid, bile and pepsin) from the stomach leak up into the oesophagus.(1,2) This can cause troublesome symptoms and/or complications such as heartburn and an unpleasant taste in the back of the mouth due to acid regurgitation.(3,4)
What are the symptoms of frequent heartburn?
Heartburn can be classified as frequent (occurring twice a week for four weeks) or infrequent (occurring once a week, a few times a month, once a month or less than once a month).(5)
Infrequent heartburn usually has no long-lasting effects.(6) Pain and discomfort caused by heartburn, if frequent, can severely limit daily activities, work productivity, sleep and quality of life.(7)
Causes of heartburn
Heartburn occurs when stomach contents flow back up into the oesophagus, often due to relaxation of the lower oesophageal sphincter (ring of muscle) or increased pressure from the abdomen at the bottom of the oesophagus.(2,4)
Certain foods or drinks can trigger symptoms of heartburn, such as:(7)
- spicy foods
- fatty or fried foods
- onions
- peppermint
- chocolate
- large meals
- citrus products
- tomato products
- alcohol
- caffeinated or carbonated beverages.
Being overweight or pregnant can also increase the risk of heartburn.(7)
What advice can pharmacy teams give patients?
The National Institute for health and Care Excellence (NICE) recommends offering patients simple lifestyle advice first line for the management of their symptoms.
Weight management
Patients should be offered advice on healthy eating and weight management if overweight or obese, because weight loss has been associated with an improvement in reflux symptoms.(8)
Smoking cessation and reducing alcohol
Reducing alcohol intake and smoking cessation may help to improve symptoms. NICE guidance advises that smoking increases gastric acid output and delays gastric emptying and alcohol can cause direct injury to the gastric mucosa. Therefore these can potentially contribute to symptoms.(9,10)
Avoidance of triggers
Patients should also be advised to avoid food and drink triggers that may aggravate symptoms of heartburn, such as acidic foods (citrus- and tomato-based products), alcohol, caffeinated beverages, chocolate, onions, garlic and peppermint. Stress and anxiety can also exacerbate symptoms of heartburn so asking patients about these can identify if they need further support. Patients should be advised to eat smaller meals, avoid eating 3-4 hours before bed and to raise the head of the bed.(9,11,12,13)
How should reflux be managed?
It is important to ask patients about the frequency of reflux symptoms. For both frequent and infrequent heartburn, if lifestyle interventions do not work, NICE recommends self-treatment with an antacid and/or alginate. Antacids should only be used for short-term treatment of symptoms.(12)
NICE advises that patients can be offered treatment with a proton pump inhibitor (PPI) if they are still experiencing symptoms after trying antacids and/or alginates. PPIs work by reducing the production of stomach acid.(9,13)
References
- National Institute for health and Care Excellence (2015) Quality standard [QS96]: Dyspepsia and gastrooesophageal reflux disease in adults.
- British National Formulary (2021) Gastro-oesophageal reflux disease.
- Katzka DA, Kahrilas PJ (2020) Advances in the diagnosis and management of gastroesophageal reflux disease. BMJ; 371:m3786 doi:10.1136/bmj.m3786.
- NHS Inform (2021) Gastro-oesophageal reflux disease (GORD).
- Peura DA, et al. (2014) Esomeprazole treatment of frequent heartburn: two randomized, double-blind, placebo-controlled trials. Postgrad Med. Jul;126(4):33-41. doi: 10.3810/pgm.2014.07.2781. PMID: 25141241.
- Oliveria SA, et al. Heartburn risk factors, knowledge, and prevention strategies: A population-based survey of individuals with heartburn. Arch Intern Med. 1999;159(14):1592–1598. doi:10.1001/archinte.159.14.1592.
- Hunt, Richard MD, et al. Coping with common gastrointestinal symptoms in the community: a global perspective on heartburn, constipation, bloating, and abdominal pain/discomfort. Journal of Clinical Gastroenterology: August 2014 - Volume 48 - Issue 7 - p567-578 doi: 10.1097/MCG.0000000000000141.
- Obesity Action (2013) Obesity and heartburn: What is the link?
- National Institute for health and Care Excellence (2018) Clinical Knowledge Summaries: Scenario: Dyspepsia - unidentified cause.
- National Institute for health and Care Excellence (2019) Clinical guideline [CG184]: Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management.
- Mayo Clinic (2020) Heartburn.
- NHS (2020) Heartburn and acid reflux.
- National Institute for health and Care Excellence (2014) Indigestion, heartburn and reflux in adults.
- Electronic Medicines Compendium (2021) Guardium acid reflux control 20mg gastro-resistant tablets.
RB-M-32698 DATE OF PREPARATION: April 2021.
IMPORTANT INFORMATION: This information is intended for healthcare professional use only: poster for display in the pharmacy only. Created in partnership with Reckitt.
PRODUCT INFORMATION: GUARDIUM ACID REFLUX CONTROL 20MG GASTRO RESISTANT TABLETS (per tablet dose): esomeprazole 20mg. Indications: The short-term treatment of refl ux symptoms (e.g. heartburn and acid regurgitation) in adults. Legal category: GSL. MAH: Reckitt Benckiser Healthcare (UK) Ltd, HU8 7DS, United Kingdom. Information about this product including adverse reactions, precautions, contra-indications and method of use can be found at: www.medicines.org.uk/emc/product/10345.
