Experts Announce New Guidelines For Heartburn Patients
New recommendations for effectively managing and treating heartburn - which affects over a quarter of the population¹ - are announced by the British Gastroenterological Forum (BGF), a panel of leading UK experts. One of its key proposals is that, under most circumstances, pharmacists should be able to manage the condition without the need for a GP referral.

Gastro-oesophageal reflux disease (GORD), of which heartburn and acid regurgitation are the main symptoms, occurs when the sphincter in the lower oesophagus relaxes and allows the contents of the stomach to return up the gullet. The condition places a real burden on people of all age groups who suffer from GORD, causing measurable impairment of their quality of life and also places a huge burden on the NHS in terms of prescriptions and GP and specialist consultations. With around 20 per cent^2,3 of people of all age groups suffering from GORD, the UK prescription drugs bill is at least £450 million a year. Each year, an estimated 1.26 million people consult their GP about heartburn⁴.

The BGF convened to consider a recent report by the American Gastroenterological Association (AGA) on the management of GORD and to make recommendations in the context of current UK practice. In particular, it looked at the role of community pharmacists and the efficacy of OTC medicines.

The BGF's UK Consensus Recommendations for the Management of GORD', released today, state that "pharmacists should be able to manage chronic long term GORD without the need for a GP referral if the patients' symptoms are adequately controlled with OTC treatment, so long as there are no changes in symptoms and …no alarm features." It recommends that appropriate regulatory measures be put in place, together with clear guidance to pharmacists on how to diagnose and manage GORD and how to recognise worrying symptoms.

Although OTC remedies have long been used in the treatment of GORD, the BGF's recommendations reflect a recent shift in emphasis away from GP consultations and towards management of the condition by pharmacists.

The BGF concludes that over-the-counter (OTC) medications - antacids, antacid/alginate, H2 antagonists or an antacid/H2 antagonist combination - have been shown in clinical trials to be effective in patients with mild-to-moderate GORD. "They may prevent symptoms, provide rapid symptom relief and reduce both symptom frequency and severity," says the BGF's report.

Commenting on the Consensus Recommendations, the BGF chair, Dr Robert Heading, until recently consultant gastroenterologist at the Royal Infirmary of Edinburgh, said: "Troublesome heartburn can cause considerable discomfort, and many patients may already seek advice on treatment from their pharmacists.

Now that modern medications have become available off prescription, community pharmacists should have a central role in helping these patients to choose the appropriate medication and manage their own symptoms safely and effectively.

The enhancement of the pharmacists' role is something physicians actively support and we believe the development will be widely welcomed by patients themselves."

1 Kennedy and Jones, Aliment Pharmacol Therap 2000, 14, 1589-94.
2 Locke R, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ: Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology 1997; 112:1448-1456.
3 Jones RH, Lydeard SE, Hobbs FD, Kenkre JE, Williams EI, Jones SJ, Repper JA, Caldow JL, Dunwoodie WM, Bottomley JM: Dyspepsia in England and Scotland. Gut 1990; 31:401-405
4 IMS.MDI Vol 1, MAT Qt 3,2003