Oct 5, 2016

By Barret Procyshyn, Pharmacist at the Dauphin Clinic Pharmacy

With Thanksgiving coming up this weekend there is likely going to be a large meal in your plans. Often with large meals comes heartburn and indigestion. The pharmacists at the Dauphin Clinic Pharmacy are always available to assist our patients with over the counter medications, which are medications that can be purchased without a prescription. One of the most common requests is advice on something to treat a burning stomach, heartburn or indigestion. Dyspepsia is the correct term to use for abdominal pain or discomfort. Dyspepsia can include heartburn, acid reflux, excessive burping, bloating and even nausea.

The most common cause of dyspepsia is a long complicated name called gastroesophageal reflux disease or simply GERD. Almost 20% of Canadians report having heartburn within a three month period and over 10% report these symptoms occur weekly. GERD can have various impacts, from being and occasional issue to a serious health problem.

Our stomachs have a one way valve, which allows food and drink into the stomach, but keeps the stomachs contents from spilling back up into the esophagus. In GERD, the stomach valve relaxes and allows the acidy stomach contents back into the esophagus, which leads to the burning and discomfort. This event is termed reflux and if reflux is allowed to continue over a long period of time erosion can occur in the esophagus leading to possible ulcers.

The good news is mild GERD symptoms can be managed with medications that do not require a prescription. I do advise you to get some advice from your pharmacist before making a purchase. We can also offer you some ways to prevent or minimize GERD as well.

GERD sufferers will notice improvement with a few, but important lifestyle modifications. You should avoid foods which irritate your symptoms, such as citrus juice, coffee and tomato products. You should avoid carbonated beverages and try to reduce alcohol intake. If one of my patients notices their symptoms are worse at night I recommend not eating within 2-3 hours of bedtime and raising the head of the bed by about 6 inches. Now all of this may not be so easy with a turkey dinner coming up this weekend, but it really does work.

Antacids are one treatment option which can help with mild symptoms. They work by reacting with stomach acid and neutralizing it. These medications are usually well tolerated and are inexpensive. Antacids do interact with other medications so make sure you ask your pharmacist if they are ok to take with your other medications. These medications can be used after eating a meal which has caused burning or discomfort. Probably the most common antacid is Tums, although it is not the most potent and usually not the most effective. An example of a product containing multiple antacids is Dioval Plus.

Some products contain sodium alginate, such as Gaviscon. It works by forming a layer on top of the gastric contents. This layer protects the esophagus from exposure to the stomach contents.

A very effective medication class available without a prescription are H2 receptor antagonists. Medications in this class include famotidine and Ranitidine or Zantac. These medications work by stopping the stomach cells from secreting as much gastric acid or stomach acid. While these medications are well tolerated, we do develop a tolerance to them over extended periods of time. They are also not effective in reducing stomach acid after a meal, so you need to take it before that bowl of chilli. I always recommend trying our Atoma brand of ranitidine first. It usually works very well and is the least expensive.

Recently Omeprazole, marketed as Olex, became available over the counter without a prescription. Although more expensive proton pump inhibitors or PPIs have shown to be even more effective than Ranitidine. PPIs work by blocking the enzyme in the wall of the stomach that produces acid. If used long term they can alter B12 absorption, however short term use is considered quite safe. Olex is available at the pharmacy, behind the counter, so talk to your pharmacist for more information. If you have third party drug coverage getting a prescription for a PPI may be beneficial as most are covered by plans like Great West Life, Sunlife and Blue Cross.

The common theme is talk to your pharmacist. We are always available to help you in the over the counter section. If we think your GERD symptoms require prescription treatment, we will refer you to a physician. If the symptoms are mild we will help you select the product which is best for you.

On behalf of the team at the Dauphin Clinic Pharmacy we wish all of you a very Happy Thanksgiving. As Canadians we all have a lot to be thankful for, so enjoy the weekend with family and friends.


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