Antacids Are Best First Choice for Indigestion

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For this study, 664 patients aged 18 years and older who had consulted with their family doctor for newly occurring indigestion were randomly selected to join one of two treatment groups. The "step-up" therapy involved initial treatment with antacids, then H2-receptor antagonists and finally proton pump inhibitors (PPIs), if needed. The "step-down" approach was just the opposite: PPIs first, then working down to antacids. Each treatment lasted four weeks, and patients only graduated to the next step if they continued to have symptoms.

Treatment success was similar in both groups: 72 percent for those doing the step-up approach and 70 percent for those doing step-down. Side effects, all minor, were also nearly equivalent.

The average medical costs were 228 Euros ($299) for those in the step-up group and 245 Euros ($322) in the step-down group. The difference was mainly due to the cost of medication, the study authors said.

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The difference in cost-effectiveness, the authors noted, narrowed when generic prices were used. PPIs are now available in any Costco store, Abreu said.

An accompanying editorial by Dr. Sander Veldhuyzen van Zanten, of the division of gastroenterology at the University of Alberta, Canada, noted that in "real life," doctors would rarely step down if there wasn't an initial response to PPIs.

"What can't be forgotten for people with this abdominal discomfort that aren't getting better with even PPIs, [is that] those are the group of people who merit further investigation to make sure they don't have some significant pathology," Abreu said.

More information

The American Academy of Family Physicians has more on indigestion.

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