Page 130 - Community pharmcy practice E-book 2025

02/11/2025, 00:29

Referral Cases (Red Flags)
Pharmacists should refer or advise medical evaluation if any of the following are present:
• Odynophagia (pain on swallowing), significant dysphagia, unexplained weight loss,
gastrointestinal bleeding, anemia.
• Symptoms of possible complications: persistent vomiting, haematemesis, melena, new-
onset chest pain (cardiac risk), severe epigastric pain.
• Persistent or recurrent symptoms despite appropriate self-care and OTC treatment (esp.
frequent or daily).
• Extra-oesophageal symptoms that may indicate other pathologies (e.g., asthma
worsening, laryngeal signs) or suspicion of Barrett’s oesophagus.
• Onset of symptoms in older age (>50) with new risk factors, or in patients with known
severe comorbidities (e.g., Barrett’s, oesophageal cancer risk).
• Pregnant women with complex/complicated reflux (need specialist review).
• Patients on medications that could complicate reflux (e.g., long-term NSAIDs) or who may
need further diagnostic work-up.

Non-Pharmacological Treatment
Lifestyle modifications are foundational. Encourage: Weight reduction if overweight or obese.
Avoid large meals, avoid high-fat/fried foods, avoid eating within ~2-3 hours of going to bed.
Elevate the head of the bed (≈15-20 cm) if symptoms are worse at night.
Avoid tight clothing, avoid bending/stooping soon after meals.
Avoid known triggers: smoking cessation, reducing alcohol/caffeine, acidic/spicy foods,
peppermint, chocolate (if triggers).
Advise small and frequent meals, drinking fluids between meals rather than large volume with
meals.

The pharmacist’s role: educate on these lifestyle measures and emphasise that drugs are
adjuncts to, not substitutes for, lifestyle change.

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