What do pharmacists need to know about heartburn?

By Dr Pulak Sahay, Consultant Gastroenterologist and Senior Lecturer of Medicine, Leeds University

What is reflux?

It is estimated that there are over 10 million adults in the UK who suffer from heartburn (sometimes known as reflux disease or Gastro-Oesophageal Reflux Disease (GORD)).  If left untreated or poorly controlled, this can cause considerable discomfort and lead to a poor quality of life. In extreme situations, untreated heartburn can cause a host of both gastrointestinal (GI) and non-GI complications, including severe complications such as Oesophageal Adenocarcinoma (OA) – known as Oesophageal Cancer.

In 2014, OA was the 6th most common cause of cancer deaths in the UK and kills an estimated 7,800 people per year, equating to 21 deaths per day1.  Data from the same year estimated the 10 year survival rate of OA at around 12%, with late diagnosis being thought as one of the contributing factors of such a low survival rate, in comparison to other forms of cancer2.  Therefore early detection can play a pivotal role in increasing the survival rate of this condition.

Scope of the Problem:
It is widely accepted that most people will suffer from heartburn at some stage in their life and people will simply accept it as a normal part of their daily life.  However, they do not appreciate that if left untreated, they are putting themselves at greater risk of developing more serious conditions, including OA.  A great deal of work needs to be done in this area to highlight to the public that suffering from heartburn is not something that can be ignored or tolerated, and that they should seek help as soon as possible to ensure that the risk of developing complications, are reduced.

Where do Pharmacists fit in?
The general public has almost unrestricted access to Pharmacists.  They are found on every high street and possess a wide variety of skills which can be used to support the public with this condition.  They are easily accessible and can play a crucial role in highlighting the need to manage this condition and how simple steps can be employed to improve the patient’s quality of life, as well as reducing the likelihood of developing the potential serious complication associated with heartburn.  Pharmacists can identify patients who may require advice when an over the counter sale of anti-reflux medication (such as antacids and alginates) is made.  Pharmacists can signpost patients, who wish to find out more information about heartburn to various resources, including websites, patient groups and charities.

One such charity is called the Campaign Against Reflux Disease (CARD).  This is a registered UK charity and their website is accessible via www.cardcharity.co.uk.  The website provides information about the condition and what patients can do to help self- manage their condition and reduce the risk of associated conditions.

Key points for Pharmacists to consider:
Any patient using anti-reflux medications for two months and are still suffering with heartburn at least twice a week, should be referred to their GP for review.  Red flag symptoms, which warrant urgent GP referral include:
• Weight loss
• Iron-deficiency anaemia
• Any GI bleeding
• Persistent vomiting
• Difficulty swallowing
• The feeling that food is getting stuck or there is a mass in their throat.

References
1. Cancer Research UK, http://www.cancerresearchuk.org/health-professional/cancer-statistics/incidence/common-cancers-compared#heading-Zero, Accessed [August 2017].
2. Cancer Research UK, http://www.cancerresearchuk.org/health-professional/cancer-statistics/survival/common-cancers-compared#heading-Zero, Accessed [August 2017].

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