Antiacid monotherapy is better than combination therapy in relieving epigastric pain

Antacid monotherapy is more effective in relieving epigastric pain than in combination with lidocaine. That is the conclusion of a study to be published in the September 2020 issue of Academic Emergency Medicine (AEM), a journal of the Society for Academic Emergency Medicine (SAEM).

The lead author of the single-center study is Dr. Jaimee Warren, a first-year physician at the Royal Melbourne Hospital, Parkville, Victoria, Australia. The findings of the study are discussed with the author in a recent AEM podcast, We Didn't Start the Fire But Can Antacid Monotherapy Stop the Fire?

The double-blind, randomized clinical trial compared three different solutions for the treatment of adults with epigastric pain or dyspepsia presenting to the emergency department (ED): antacid monotherapy, antacid/lidocaine 2% solution, and antacid/lidocaine 2% viscous gel.

Warren, et al. concluded that all three treatments worked and there was no statistical difference in pain relief among the groups at 30 and 60 minutes; however, antacid monotherapy was found to be the most palatable solution, with statistically significant differences in taste, bitterness, and overall acceptability, and there were fewer side effects.

In conclusion, the study authors recommend using antiacid monotherapy in place of lidocaine/antacid combination therapy for management of dyspepsia and epigastric pain for patients in the ED.

This study nicely demonstrates that 'more' is not always synonymous with 'better' when it comes to treating pain. Antacid alone appears to be equally efficacious to antacid-lidocaine combinations, without any of the unpleasant side effects that may discourage its use. This is important information to provide to patients as antacids are available over-the-counter, thereby allowing patients to manage their symptoms without a visit to the emergency department."

Robert Ehrman, MD, MS, Research Faculty, Department of Emergency Medicine, Wayne State School of Medicine, Detroit