Treatment options

Treatment for indigestion and heartburn will depend on the cause and how severe the symptoms are. 

For someone who only suffers mild and occasional symptoms, lifestyle changes – particularly those relating to eating habits – may be enough to relieve symptoms and prevent recurrences. OTC remedies generally fall into two categories: products that neutralise excess acid (antacids), and those that reduce acid production (proton pump inhibitors).

Lifestyle

Remember to be tactful when offering advice on combating indigestion and heartburn, particularly if the root cause is likely to be some form of overindulgence. 

Here are some tips pharmacy teams can pass on: 

• Try to identify and then avoid triggers. Keeping a food diary may help to track which foods trigger symptoms
• Limit fried food, caffeine and alcohol
• Eat regular meals at a sensible pace
• Cut back smoking – ideally, give up altogether
• Lose weight if necessary
• Exercise regularly to improve muscle tone
• Symptoms that occur at night may lessen if the last meal of the day is eaten earlier. Propping up the head and shoulders while in bed, for example by using an extra pillow, may also help
• Relaxation techniques such as yoga and meditation can help to ease stress
• If medication might be an issue, discuss changing the drug itself or how it is taken with the pharmacist. For example, taking some medicines after food lessens the chance of them irritating the stomach. 

Medication 

Antacid remedies neutralise stomach acid and are generally considered first-line treatment, after or alongside lifestyle changes.

Aluminium and magnesium salts frequently form the base of these products, sometimes in combination so the respective side effects of constipation and diarrhoea cancel each other out.

Antacids can react with other medicines, so it is always important to ask customers if they are taking anything else when recommending or selling such products.

Alginates, or rafting agents, form a layer that sits above the stomach contents and stops them leaking into the oesophagus.

Liquids have a quicker effect than tablets, which should always be sucked or chewed rather than swallowed, and all products are best taken about an hour after eating rather than immediately afterwards.

OTC examples include Gaviscon Advance, Bisodol and Pepto-Bismol. Products such as Gaviscon Double Action contain both an alginate and an antacid.

Acid-reducing agents

If antacids haven’t resolved the symptoms, an acid reducing agent may help. 

The proton pump inhibitors (PPIs) omeprazole, esomeprazole and pantoprazole block acid production in the stomach. They start to work within one to two hours of taking the first dose, but two to three days’ treatment may be needed for the full benefit to be felt. OTC examples include Guardium Acid Reflux Control and Nexium Control. 

Another option for the reduction of acid reflux, indigestion, heartburn and nausea is Bismuth Subsalicylate. This is also a mild antacid that protects the stomach and lower oesophagus from stomach acid.

All OTC acid-reducing medicines should not be used long term, and there are various restrictions regarding their sale. Check packs carefully when recommending or selling these products to customers.