Patient journey in gastroesophageal reflux disease: real-world perspectives from Italian gastroenterologists, primary care physicians, and ENT specialists.
Andrea Pasta, Filippo Pelizzaro, Elisa Marabotto, Francesco Calabrese, Elena Formisano, Shirin Djahandideh Sheijani, Giovanni Brandimarte, Giampiero Manes, Antonietta Gerarda Gravina, Edoardo Vincenzo Savarino
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Abstract
Background: Gastroesophageal reflux disease (GERD) is a challenging condition that involves different physicians, such as general practitioners (GPs), gastroenterologists, and ears, nose and throat (ENT) specialists. A common approach consists of proton-pump inhibitors (PPIs) administration. Adjunctive pharmacological treatment may have a role in the management of non-responders to PPIs.
Objectives: We aimed to survey GPs and different medical specialists to investigate the medical approaches to patients reporting GERD symptoms. In addition, we examined the use of adjunctive pharmacological treatments in patients with GERD symptoms who do not respond to PPIs.
Design: Retrospective observational study.
Methods: A survey was conducted among a large sample of gastroenterologists, GPs, and ENT specialists. Symptoms were divided into typical and extraesophageal, and their severity and impact on quality of life were explored with the GERD Impact Scale and with Reflux Symptom Index (RSI). All therapies administered usually for GERD were investigated.
Results: A total of 6211 patients were analyzed in this survey. Patients with typical symptoms were 53.5%, while those with extraesophageal symptoms were 46.5%. The latter were more frequently reported by ENT patients (53.6%, p < 0.0001). The GSI was higher in patients followed by gastroenterologists (9 points) and GPs (9 points) than ENT specialists (8 points), but the RSI was higher in the ENT group (14.3 ± 6.93) than in GPs and gastroenterologist groups (10.36 ± 6.36 and 10.81 ± 7.30, p < 0.0001). Chest pain had the highest negative impact on quality of life (p < 0.0001). Of the 3025 patients who used PPIs, non-responders showed a lower GSI when treated with a combination of adjunctive pharmacological treatments and bioadhesive compounds, than with single-component drugs.
Conclusion: Patients with GERD referred to a gastroenterologist had more severe disease and poorer quality of life. The combination of adjunctive pharmacological treatments and bioadhesive compounds seems to be effective in the management of PPI refractory patients.
背景：胃食管反流病（GERD）是一种具有挑战性的疾病，涉及不同的医生，如全科医生（GP）、肠胃病专家和耳鼻喉科专家。常见的治疗方法包括服用质子泵抑制剂（PPIs）。对于质子泵抑制剂无效的患者，辅助药物治疗可能会起到一定的作用：我们的目的是对全科医生和不同的医学专家进行调查，以了解对报告有胃食管反流症状的患者采取的医疗方法。此外，我们还研究了对 PPIs 无应答的胃食管反流病患者使用辅助药物治疗的情况：设计：回顾性观察研究：方法：对胃肠病专家、全科医生和耳鼻喉科专家进行大样本调查。症状分为典型症状和食管外症状，并通过胃食管反流影响量表（GERD Impact Scale）和反流症状指数（RSI）探讨了症状的严重程度及其对生活质量的影响。对所有通常用于治疗胃食管反流病的疗法进行了调查：本次调查共分析了 6211 名患者。有典型症状的患者占 53.5%，有食道外症状的患者占 46.5%。后者更多由耳鼻喉科患者报告（53.6%，p p p p 结论：转诊至消化内科医生的胃食管反流病患者病情更严重，生活质量更差。在治疗 PPI 难治性患者时，将辅助药物治疗和生物黏附剂结合使用似乎很有效。
期刊介绍：
Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area.
The editors welcome original research articles across all areas of gastroenterology and hepatology.
The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.
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