Meining A, Driesnack U, Classen M, Rösch T
II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Germany.
Z Gastroenterol. 2002 Jan;40(1):15-20. doi: 10.1055/s-2002-19638.
The incidence of gastroesophageal reflux disease (GERD) is increasing. Although guidelines have been issued on the diagnosis and treatment of GERD, the way in which these should be applied in everyday practice is unclear. The aim of the present survey was to interview private-practice physicians on their personal opinions concerning the management of GERD.
A questionnaire based on the case of a typical patient with reflux was sent out to a total of 918 private-practice physicians. The questions concerned general measures for avoiding reflux symptoms (dietary and lifestyle modifications), the diagnosis of GERD, and the type and dosage of antireflux treatment.
A total of 255 questionnaires were evaluated (28 %), which had been returned by 151 family doctors, 63 internal medicine specialists, and 41 gastroenterologists. 70 % of the respondents carry out specific diagnostic tests (endoscopy in 98 % of cases) prior to treatment. Altering specific dietary and lifestyle factors (such as sleeping position) was considered useful by the majority of respondents. 99 % of the physicians administer some form of GERD therapy, and 88 % of the internists/gastroenterologists and 74 % of family doctors (P = 0.006) do so using a "step-down" approach (with proton-pump inhibitors as the initial strategy). With the "step-up" procedure, the initial recommendation includes primarily antacids, with a change to more effective drugs only when symptomatic relief is not achieved.
The current guidelines on the diagnosis and treatment of GERD are largely adhered to, particularly by specialists. In addition to the well-established drug treatment, empirical recommendations on dietary and lifestyle measures still form part of the management of GERD, despite the lack of scientific evidence to support them.
胃食管反流病（GERD）的发病率正在上升。尽管已经发布了关于GERD诊断和治疗的指南，但在日常实践中应如何应用这些指南尚不清楚。本次调查的目的是就私人执业医生对GERD管理的个人意见进行访谈。
基于一名典型反流患者的病例设计了一份问卷，共发送给918名私人执业医生。问题涉及避免反流症状的一般措施（饮食和生活方式改变）、GERD的诊断以及抗反流治疗的类型和剂量。
共评估了255份问卷（28%），这些问卷由151名家庭医生、63名内科专家和41名胃肠病学家返回。70%的受访者在治疗前进行特定的诊断测试（98%的病例进行内镜检查）。大多数受访者认为改变特定的饮食和生活方式因素（如睡眠姿势）是有用的。99%的医生进行某种形式的GERD治疗，88%的内科医生/胃肠病学家和74%的家庭医生（P = 0.006）采用“逐步递减”方法（以质子泵抑制剂作为初始策略）。采用“逐步递增”程序时，初始建议主要包括抗酸剂，只有在症状未缓解时才改用更有效的药物。
目前关于GERD诊断和治疗的指南在很大程度上得到遵循，尤其是专家。除了成熟的药物治疗外，尽管缺乏科学证据支持，但关于饮食和生活方式措施的经验性建议仍是GERD管理的一部分。
