Proton pump inhibitors (PPIs) are the mainstay of treatment for acid-related diseases in the upper gastrointestinal tract. In Australia in 2017–18, the PPIs esomeprazole and pantoprazole were the third and fourth most-prescribed medicines by volume on the Pharmaceutical Benefits Scheme, after two statins.1 Gastro-oesophageal reflux disease (GORD) is a common presenting condition in Australian primary care. A 2012–14 analysis found that 65% of PPIs ordered by general practitioners were for GORD.2
Although GORD is generally an intermittent disease, many patients continue on PPI treatment long term. This leads to unnecessary personal and healthcare costs to treat mild, intermittent symptoms.3 Even with a diagnosis of GORD, managing aggravating factors can help relieve symptoms.
Pharmacists can encourage patients to make dietary and lifestyle changes, and assist them identify medicines that exacerbate symptoms.
Dietary measures: Avoid common triggers including spicy/fatty foods, large meals, caffeinated drinks, alcohol and chocolate. Also use measures such as eating smaller meals and avoiding lying down after eating.3,4
Medicinal triggers: Identify common triggers such as aspirin/non-steroidal anti-inflammatory drugs (NSAIDs), bisphosphonates, calcium channel blockers, nitrates, drugs with anticholinergic effects, and ben
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