Treatment of Heartburn in Patients with Ulcerative Colitis
Proton pump inhibitors (PPIs) at full dose, such as lansoprazole 30 mg or omeprazole 20 mg once daily, are the first-line treatment for heartburn in patients with ulcerative colitis. 1, 2
First-Line Therapy: Full-Dose PPIs
Full-dose PPI therapy (omeprazole 20 mg once daily or lansoprazole 30 mg once daily) should be initiated as first-line treatment for patients with ulcerative colitis experiencing heartburn or epigastric pain. 1
PPIs are particularly effective when heartburn is the predominant or most bothersome symptom, as this indicates acid-related disease. 1
Lansoprazole 30 mg daily has demonstrated superior efficacy compared to lower doses (15 mg) for symptomatic GERD, with 81-95% of patients achieving freedom from heartburn by week 4-8. 2
Response to PPI therapy confirms the acid-related nature of symptoms and validates the treatment approach. 1
Treatment Duration and Approach
An initial course of empirical PPI therapy should be given, with assessment of symptom control. 1
If symptoms are controlled, consider a trial of withdrawal with therapy repeated upon symptom recurrence, or transition to on-demand therapy with the successful agent. 1
Continue PPI therapy as needed for symptom control, as this approach has been shown to reduce subsequent costs and positively impact quality of life over a 3-month period after acute treatment. 1
Important Considerations for UC Patients
Heartburn may emerge as the predominant symptom after H. pylori eradication in UC patients, requiring initiation of PPI therapy even if not initially apparent. 1
Approximately 50% of patients on systemic corticosteroids for UC experience dyspepsia as an adverse effect, which may manifest as heartburn. 3
PPIs do not interfere with ulcerative colitis treatment and can be safely used alongside 5-ASA compounds, corticosteroids, immunomodulators, or biologic therapies. 1
When to Escalate Care
If symptoms persist despite switching from one PPI to another or after a trial of high-dose PPI therapy, refer for endoscopy to evaluate for alternative diagnoses or complications. 1
Rule out misclassified GORD (gastroesophageal reflux disease) in patients with atypical presentations or refractory symptoms. 1
Common Pitfalls to Avoid
Do not delay PPI initiation in favor of antacids or H2-receptor antagonists, as PPIs provide superior symptom relief and healing rates. 1, 2
Do not assume heartburn is related to UC disease activity—it is typically a separate acid-related condition requiring specific anti-reflux therapy. 1
Avoid using NSAIDs for other UC-related symptoms (such as arthralgia) in patients with active heartburn, as NSAIDs can worsen gastroesophageal symptoms and require prophylactic PPI therapy. 1, 3