What this protocol covers
The query about heartburn, acid or reflux: what fits if it is occasional or frequent, which habits help and which signs point to something else.
1. What to ask
- How often does it happen? Is it linked to meals or to lying down?
- How old are they, and is it the first time?
- Do they find it hard to swallow, have they lost weight without trying, are they vomiting, have they seen blood or black stools?
- Do they take anti-inflammatories, aspirin, anticoagulants, clopidogrel, bisphosphonates or iron?
- Are they pregnant?
2. Refer if any of these appear
- Pain that spreads to the arm, neck or jaw, or comes with sweating, nausea or shortness of breath: it may be the heart. Emergency department.
- Difficulty or pain swallowing, weight loss, repeated vomiting, vomiting blood or black stools.
- First time after the age of 55.
- More than 2 weeks of symptoms despite treatment, or needing an antacid every day.
- Taking NSAIDs or anticoagulants and having heartburn or stomach pain.
3. If there are no red flags
Occasional heartburn
- An antacid (magnesium and aluminium salts, calcium carbonate) or an alginate, after meals and at bedtime.
- They work within minutes; the effect does not last long.
Frequent symptoms (two or more days a week)
- Omeprazole 20 mg or pantoprazole 20 mg once a day, before breakfast, for up to 14 days.
- It takes a few days to work fully: it is not for one-off heartburn.
- If it has not settled after 14 days, or comes back as soon as they stop, they should see the doctor.
Habits that help
- Eating the evening meal at least two or three hours before bed, and a smaller one.
- Raising the head of the bed if there is night-time reflux.
- Cutting down on alcohol and smoking, and losing weight if overweight.
4. Adjust to who will take it
- Pregnancy
- Habits, alginates and calcium antacids. Proton pump inhibitors on medical advice.
- Kidney disease
- Avoid repeated use of antacids containing magnesium or aluminium.
- Long-term conditions
- With clopidogrel, omeprazole and esomeprazole can reduce its effect: pantoprazole is preferred and their doctor is consulted.
- Older people
- Heartburn appearing for the first time after 55 is assessed by the doctor.
What not to recommend
- Antacids at the same time as other medicines: keep about 2 hours apart from levothyroxine, iron, quinolones or tetracyclines.
- Sodium bicarbonate on a regular basis, because of the sodium.
- Proton pump inhibitors for more than 14 days without a doctor assessing it.
What to say at the counter. If it is now and then, this after meals. If it happens almost every day, this other one before breakfast for two weeks; if it does not go, or you find it hard to swallow or lose weight, see the doctor.
Pharmacy Pills · conveniodefarmacia.com
Patient sheet: heartburn
To print and hand over. It carries only what the patient needs at home.
- Eat your evening meal early and light, and do not lie down straight after eating.
- If you take an antacid, keep it about 2 hours apart from your other medicines.
- Omeprazole without a prescription is for 14 days at most, before breakfast.
- Go to the emergency department if the pain spreads to your arm or neck, or comes with sweating or shortness of breath. See your doctor if you find it hard to swallow, lose weight or see blood or black stools.
Self-assessment
Three questions. When you check your answers you will see the explanation for each one.
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A first episode after 55 and weight loss are red flags.
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Antacids reduce the absorption of levothyroxine, iron and other medicines if taken at the same time.
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Without a prescription, up to 14 days. If it does not settle or comes back, they see the doctor.
Training content. It does not replace the summary of product characteristics or clinical judgement.