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AMBULATORY CARE

Self-Medication of Upper Gastrointestinal Symptoms: A Community Pharmacy Study

Postdoctoral Researcher, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium

Luc Van Bortel, MD PhD

Professor of Clinical Pharmacology, Heymans Institute of Pharmacology, Faculty of Medicine and Health Sciences, Ghent University

Leen De Bolle, MSPharm PhD

Postdoctoral Researcher, Faculty of Pharmaceutical Sciences, Ghent University

Inge Van Tongelen, MSPharm

Research Associate, Faculty of Pharmaceutical Sciences, Ghent University

Jean-Paul Remon, MSPharm PhD

Professor of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, Ghent University

Danny De Looze, MD PhD

Professor of Gastroenterology, Department of Gastroenterology, Ghent University Hospital

Reprints: Dr. Mehuys, Pharmaceutical Care Unit Ghent, Faculty of Pharmaceutical Sciences - Ghent University, Harelbekestraat 72, 9000 Ghent, Belgium, fax 32 (0) 9 222 82 36, els.mehuys{at}ugent.be

BACKGROUND: Upper gastrointestinal (GI) symptoms are a common reason for self-treatment with over-the-counter (OTC) medication. However, data are scarce on the typology of GI complaints for which individuals seek self-medication and, more importantly, on the prevalence of alarm symptoms in this population.

OBJECTIVE: To investigate: (1) the nature of GI symptoms that people intend to self-medicate, (2) prevalence of alarm symptoms, (3) adherence to referral advice given by the pharmacist, and (4) self-reported efficacy and frequency of use of OTC medication for minor complaints.

METHODS: This descriptive study was performed in 63 community pharmacies. Participants (N = 592, aged 18-82 y) completed a questionnaire to assess symptom characteristics and previous medical consulting. Based on this information, the pharmacist referred subjects to a physician or advised self-treatment. Four weeks later, participants were presented a follow-up questionnaire evaluating their adherence to referral advice or efficacy of self-treatment.

RESULTS: The most frequently reported GI symptoms were burning retrosternal discomfort (49.2%), acid regurgitation (53.2%), and bothersome postprandial fullness (51.2%). At least one alarm symptom was present in 22.4% of the individuals, with difficulty in swallowing being the most prevalent (15.4%). Although 21% of the customers were referred, only 51.7% of these contacted a physician. Almost all (95.1%) of the remaining customers who were advised self-treatment reported symptom relief with the OTC drug obtained.

CONCLUSIONS: Mild GI symptoms will mostly resolve with self-treatment. Yet, the value of pharmacist counseling on OTC treatment should be recognized, as community pharmacists can play an important role in distinguishing symptoms that warrant further medical examination.

Key Words: antacid, dyspepsia, nonprescription drugs, self-treatment, upper gastrointestinal symptoms

Published Online, May 5, 2009. www.theannals.com, DOI 10.1345/aph.1L647