INDIGESTION (DYSPEPSIA) AND HEARTBURN (ACID REFLUX)
Symptoms: A gnawing or burning stomach pain, bloating, heartburn (acid reflux), upset
stomach, vomiting and belching which often results from overeating, eating high fat meals or
being overweight. These symptoms should normally resolve within one or two weeks. Common
causes include acid reflux , inflammation, medicines, infection with H. pylori, or a hiatus hernia.
Rarely, a stomach ulcer or cancer of the stomach or gullet may be responsible.
Pharmacist
should refer to a clinician if the patient presents with any of the following Red
Red
flags
Flags
• Pain/ other stomach/ chest symptoms - Severe,
persistent pain (longer than three weeks),
worsening and unexplained pain in the upper
abdomen, particularly if occurring with other
symptoms, such as pain in the chest, pain radiating
through the back to the arms, breathlessness,
sweating, feeling sick and vomiting
• Vomiting blood - or dark lumps (like coffee
grounds)
• Dark stools - Stool colour has become very dark
(looking like tar) – N.B. iron tablets can also cause
this and need to be ruled out
• Feeling faint
• NSAIDs – regular long term use of prescribed
NSAIDs
For more information:
NHS Choices
http://www.nhs.uk/con
ditions/indigestion/Page
s/Introduction.asp
Always follow WWHAM protocol and
advise to read PIL before taking any
medicine
• Unexplained fever, night sweats
Significant interactions/warnings
•Swelling or mass in the upper abdomen
• Unexplained weight loss
• Recurrent symptoms
Omeprazole and Pantoprazole
• Anti-coagulants/platelet drugs –
enhances blood thinning
• Phenytoin – enhances effects of
phenytoin
• Proven anaemia
• Difficulty in swallowing
Caution:
• Pregnant or breastfeeding
• Age – Particular care should be taken in those
aged 55 years and over
Antacids
• These should not be taken at the same
time (2hrs) as other drugs since they may
impair the absorption of other drugs
Please refer to the British National Formulary and
individual product packaging for cautions and contraindications
Self care advice
• Smoking - Reduce or stop smoking, which may help improve symptoms.
• Avoiding NSAID/aspirin-like drugs - If taking OTC anti-inflammatory pain killers (consult GP if taking prescribed NSAIDs)
• Avoid stress
• Diet - Eat small regular meals and reduce the amount of fatty or spicy foods in the diet
• Alcohol and caffeine - Reduce caffeine and alcohol intake
• At bedtime - If experiencing indigestion symptoms at night, avoid eating for three to four hours before going to bed as there is an increased risk that
acid in the stomach will be forced up into the oesophagus while they are lying down
• Healthy weight - Being overweight puts more pressure on the stomach, making it easier for stomach acid to be pushed back up into the oesophagus
Treatment option ONE
Antacid containing
product
Intermittent
symptoms
Alginate containing
product
Antacid and alginate
combination product
Always follow WWHAM protocol and advise to read PIL before
taking any medicine
These products are best taken
• After meals
• Before bedtime
These products can be used up to its maximum dose for up to one week, please see the individual
packs for guidance on dosage instructions. If symptoms do not improve or the symptoms quickly
return after the effects of the product have worn off, then recommend products for persistent
symptoms
Antacids work by altering the acidity of the stomach contents. It decreases the acidity which help relieve the pain and discomfort of the heartburn and
indigestion.
Alginates work by forming a raft (thick layer) on top of the stomach contents soon after it had made contact with the stomach acid. The raft acts as a
strong physical barrier and helps keep all the components of the stomach contents in the stomach where they work, not letting them seep back up into
the oesophagus where they hurt.
Proton pump
inhibitors
E.g.Pantoprazole,
Omeprazole
Take ONE Pantoprazole 20mg tablets per day. It might be necessary to take these tablets for 2-3
consecutive days to see any improvement of symptoms. Once symptoms have resolved treatment
should be discontinued. If symptoms do not improve within TWO weeks of continuous treatment
refer to the pharmacist.
Take up to TWO Omeprazole 10mg tablets per day for up to TWO weeks or until symptoms have
resolved. It might be necessary to take these tablets for 2-3 consecutive days to see any
improvement of symptoms. Once symptoms have resolved treatment should be discontinued.
If symptoms do not improve within TWO weeks of continuous treatment refer to the pharmacist.
Persistent
symptoms
H2 antagonists
E.g. Ranitidine
Take ONE Ranitidine 75mg tablet as soon as symptoms occur. If symptoms persist for more than one
hour or return, one more tablet may be administered up to its maximum dose.
For prevention of symptoms associated with consuming food and drink, take ONE tablet half to one
hour before eating or drinking.
If symptoms do not improve within TWO weeks of continuous treatment refer to the pharmacist.
Proton pump inhibitors work by blocking the release of acid in the stomach. They are the only licensed preparations of this type of medication that are
available OTC and are only suitable for adults ages 18 and over.
H2 antagonist work by reducing stomach acid indirectly by preventing the activation of acid production. It can relieve heartburn associated with acid
indigestion, and it can relieve heartburn fast. This medication may only used in people aged 16 and over.
Follow-up Treatment – Pharmacist only
Antacid containing
product
Intermittent
symptoms
Alginate containing
product
Antacid and alginate
combination product
Always follow WWHAM protocol and advise to read PIL before
taking any medicine
These products are best taken
• After meals
• Before bedtime
These products can be used up to its maximum dose for up to a WEEK, please see the individual
packs for guidance on dosage instructions. If symptoms do not improve or the symptoms quickly
return after the effects of the product have worn off, then recommend products for persistent
symptoms
Antacids work by altering the acidity of the stomach contents. They decreases the acidity which help relieve the pain and discomfort of the heartburn
and indigestion.
Alginates work by forming a raft (thick layer) on top of the stomach contents soon after making contact with the stomach acid. The raft acts as a strong
physical barrier and helps keep all the components of the stomach contents in the stomach, and not letting them seep back up into the oesophagus
where they hurt.
Proton pump
inhibitors
E.g.Pantoprazole,
Omeprazole
Take ONE Pantoprazole 20mg tablets per day. It might be necessary to take these tablets for 2-3 consecutive
days to see any improvement of symptoms. Once symptoms have resolved treatment should be discontinued.
Take up to TWO Omeprazole 10mg tablets per day for up to TWO weeks or until symptoms have resolved. It
might be necessary to take these tablets for 2-3 consecutive days to see any improvement of symptoms. Once
symptoms have resolved treatment should be discontinued.
For BOTH treatments if symptoms have improved but not fully resolved within TWO weeks, continue
treatment for a further TWO weeks and add Gaviscon suspension for occasional breakthrough symptoms. If
symptoms do not improve within FOUR weeks of treatment refer to the GP
Persistent
symptoms
H2 antagonists
E.g. Ranitidine
Take ONE Ranitidine 75mg tablet as soon as symptoms occur. If symptoms persist for more than one hour or
return, one more tablet may be administered up to its maximum dose.
For prevention of symptoms associated with consuming food and drink, take ONE tablet half to one hour
before eating or drinking.
If symptoms have improved but not fully resolved within TWO weeks, continue treatment for a further TWO
weeks and add Gaviscon suspension for occasional breakthrough symptoms. If symptoms do not improve
within FOUR weeks of treatment refer to the GP
Proton pump inhibitors work by blocking the release of acid from the stomach. They are the only licensed preparations of this type of medication that
are available OTC and are only suitable for adults ages 18 and over.
H2 antagonists work by reducing stomach acid indirectly by preventing the activation of acid production. Can relieve heartburn associated with acid
indigestion, and fast. This medication may only used in people aged 16 and over.