Several epidemiological studies have shown that a high percentage of people with dyspepsia have tried OTC products as an initial step in management of their symptoms. OTC drugs include antacids, alginate-based products, H2RAs, bismuth products and herbal products. Published studies of these agents include few randomly assigned controlled trials and relate to a broad spectrum of patient populations, primarily functional dyspepsia or heartburn-predominant dyspepsia patient populations.
Antacid products have been shown to provide symptomatic relief of heartburn in some but not all studies , but have no effect on healing of erosive esophagitis. They may provide more prompt symptom relief than OTC doses of ^RAs . Thus, the evidence suggests that antacids should be used for unpredictable episodes of heartburn and for symptomatic ‘breakthrough’ episodes of heartburn. Several studies suggest that the benefit of antacids probably stems from their ability to provide intraesophageal neutralization of acid rather than neutralization of acid present in the stomach. ^RAs in OTC formulations containing one-half of the prescription strength product per unit dose (eg, ranitidine 75 mg, famotidine 10 mg) do lower gastric acid secretion. Randomly assigned controlled trials of these agents (low-dose OTC cimetidine, ranitidine, famotidine) have shown that these products produce significantly greater relief or prevention of postprandial reflux symptoms than placebo.