IPN August 2022

Topic Team Training – Heartburn

A community pharmacy environment that fosters teamwork ensured high levels of consumer satisfaction. This series of articles is designed for you to use as guide to assist your team in focusing on meeting ongoing CPD targets and to identify any training needs in order to keep the knowledge and skills of you and your team up to date.

The below information, considerations and checklist provides support to enable you to run a team training session and identify opportunities for learning within the topic of Heartburn.

Burning Issue

Community Pharmacists are likely to see many heartburn patients. Heartburn can be relatively benign or become a frequent problem that can have great impact on the patient’s quality of life.

Heartburn is a burning feeling in the chest caused by stomach acid travelling upwards towards the throat (acid reflux).

The main symptoms of acid reflux are:

• heartburn – a burning sensation in the middle of the chest

• an unpleasant sour taste in the mouth, caused by stomach acid

Some may also have:

• a cough or hiccups that keep coming back

• a hoarse voice

• bad breath

• bloating and feeling sick

Symptoms will probably be worse after eating, when lying down and when bending over.

The groups at risk include those in poor health, particularly the over 55s who are more likely to be overweight and/or have other medical conditions, and people exposed to stress.

Most patients know what causes their heartburn. Citrus juices, bread, coffee, cucumber, and rich and spicy meals are common triggers. Overindulgence in food and alcohol (especially right before bed), smoking, excess weight, and stress are other common causes.

If someone has heartburn incidences more than three times a week they may have a more serious underlying problem such as gastro oesophagael reflux disease (GORD). This condition results in the contents of the stomach to back up, or reflux, into the oesophagus.

Pharmacy Advice

Pharmacists should ask openended questions about concurrent medications and supplements, such as NSAIDs, aspirin, glucosamine, and others, that may list heartburn among their side effects.

Sometimes pointed questions about lifestyle can help patients select appropriate lifestyle modifications. Pharmacists should remember that for gastrointestinal reflux, certain symptoms should raise an alarm. If patients report any symptom indicative of one of these, referral to a physician is warranted.

Treatments

Many OTC medications can help relieve heartburn. The options include:

• Antacids, which help neutralize stomach acid. Antacids may provide quick relief. But they can’t heal an esophagus damaged by stomach acid.

• H2 blockers, which can reduce stomach acid. H2 blockers don’t act as quickly as antacids, but they may provide longer relief. Examples include cimetidine (Tagamet HB) and famotidine (Pepcid AC).

• Proton pump inhibitors, which also can reduce stomach acid. Examples include esomeprazole, lansoprazole and omeprazole

Pepcid Duo is a new improved version of Pepcid. It combines the benefits of Famotidine (a H2 receptor blocker) and antacids in one chewable tablet to treat the short term symptoms of heartburn, acid indigestion (dyspepsia) and excess acid.

It is suitable for those aged over 16.Antacids

Calcium Carbonate and magnesium hydroxide neutralise the exisiting acid in the stomach.

H2 Blocker

Famotidine is effective at reducing the amount of acid the stomach produces.

Refer patients to the GP if they:

• have been self-treating unsuccessfully continuously for ≥4 weeks

• are ≥45 years old with new or recently changed indigestion symptoms

• have unintended weight loss in association with indigestion

Consider:

• Am I/my team familiar with the differences between heartburn, GORD, indigestion and other GI disorders to make an educated diagnosis?

• Am I/my team aware of the symptoms of heartburn?

• Am I/my team aware of contributing causes of heartburn in order to advise sufferers of lifestyle changes?

• Do I know what to recommend if a customer returns saying the treatment has not worked?

• Am I aware of the drug interactions for OTC heartburn medicines?

Key Points:

Check your pharmacy team are aware and understand the following key points:

• Some antacids contain sodium, which should be avoided by those on saltrestricted diets

• Two to three days’ treatment may be needed before the full benefit of proton pump inhibitors is felt

• H2 antagonists can be used as soon as symptoms start and as a preventive measure

• Sufferers should see their doctor if no relief is obtained within two weeks of continuous treatment

Actions:

• Include POS with associated condition treatments such as other indigestion

• Ensure efficient sign posting to further help and advice or reputable sources for hheartburn treatment

• Ensure there is a discreet area in which staff can assist with advice and product selection

• Keep products merchandised together, along with related products to help build sales

• Ensure the team are able to communicate lifestyle advice

• Train the team to meet all the above considerations