Review: over-the-counter medications are effective for gastro-oesophageal reflux disease
Q Are over-the-counter medications effective for gastro-oesophageal reflux disease (GORD)?
Medline (to 2005), reference lists, abstracts of scientific meetings, and drug manufacturers.
Study selection and assessment:
English language randomised controlled trials (RCTs) that compared an antacid, alginate-antacid combination, or histamine-2 receptor antagonist (H2RA) at over-the-counter doses with placebo for treatment of GORD in adults and reported outcomes of interest (see below). 14 RCTs involving 18 comparisons (n = 7021) met the selection criteria. Quality of individual trials was assessed using the Jadad score.
adequate relief of GORD symptoms, subjective global improvement, and use of rescue antacids.
Antacids provided greater subjective improvement and less use of rescue antacids than placebo (table). The alginate-antacid combination provided greater subjective improvement than placebo (table). H2RAs provided better relief of symptoms, greater subjective improvement, and less use of rescue antacids than placebo (table).
Over-the-counter medications, such as antacids, alginate-antacid combinations, and histamine-2 receptor antagonists, are more effective than placebo for treatment of gastro-oesophageal reflux disease.
- D Shane Strickland, RN, MScN
GORD is on the rise, with some estimates indicating that 40% of the North American population experience monthly symptoms1 and that GORD is now more common than ulcers in Canada.2 The potential of over-the-counter antacids, alginates, and H2RAs as treatment options for controlling mild and intermittent GORD had not previously been studied systematically. The findings of the meta-analysis by Tran et al clearly demonstrate the effectiveness of these over-the-counter medications for treatment of mild symptomatic GORD. However, caution should be noted when counselling patients in self management.
GORD treatment guidelines recommend lifestyle modification in the management of mild symptoms, despite a dearth of evidence supporting this approach.2,3 It may be that lifestyle modification in combination with over-the-counter agents may provide enhanced symptom relief, but more trials are needed. In addition, some studies indicate that patients delay seeking treatment for GORD symptoms; therefore, counselling should include an emphasis on immediately returning for further investigation if over-the-counter treatments are not effective or stop being effective. Unresolved chronic GORD is an important risk factor for developing Barrett oesophagus.3
Although comparative trials are still needed, the meta-analysis by Tran et al provides evidence for the role of over-the-counter antacids, alginates, and H2RAs in the treatment of mild symptomatic GORD. However, caution is warranted because persistent or more severe symptoms may be masked or ignored by patients when self managing GORD symptoms with over-the-counter therapies.
For correspondence: Dr H B El-Serag, Houston Veterans Affairs Medical Center, Houston, TX, USA.
Source of funding: no external funding.