Gastric reflux management in pharmacy

Abstract

Gastroesophageal reflux disease (GERD) is a widespread disease, as about a quarter of the Western population has GERD symptoms at least weekly, and GERD is the most frequent reason for outpatient gastroenterology consultation. Laryngopharyngeal reflux (LPR) is the extra-oesophageal counterpart of GERD, as the upper airways are the target of the extraesophageal spill out of gastric contents. GERD and LPR treatment are commonly based on proton pump inhibitor (PPI) use, but PPI may be ineffective in some patients and potentially unsafe if administered for a very long time. As a result, other therapeutic options include alginates and antacids. Most of the compounds used for managing gastric reflux are available as over the counter products or medical devices. Thus, pharmacist plays an active role in advising these products. The current experience resulted from the involvement of a group of Italian pharmacists who participated in an educational project on managing gastric reflux problems. This experience, involving 372 Italian pharmacies, provided some interesting findings. First, 63% of subjects visiting a pharmacy required treatment for GERD, and 38% had LPR. Moreover, more than 40% of subjects did not follow a correct diet or adequate gastric reflux lifestyle. In this regard, the pharmacist advised a diet and lifestyle change in 43% of subjects as a first-line option. PPI was the most common medication, both as monotherapy or polytherapy, about past or concomitant treatment for gastric reflux symptoms. Alginates were the second choice as both alone or add-on. Very notably, the updating of the knowledge about gastric reflux significantly affected the attitude of pharmacists to advise OTC products. As a result, there was a reduction of PPI suggestions and increased alginates. In particular, the combined strategy, such as the PPI add-on to alginates, was the most common option.