Chey William D, Inadomi John M, Booher Anna M, Sharma Virender K, Fendrick A Mark, Howden Colin W
University of Michigan Health System, Ann Arbor, Michigan 49109-0362, USA.
Am J Gastroenterol. 2005 Jun;100(6):1237-42. doi: 10.1111/j.1572-0241.2005.41364.x.
Gastroesophageal reflux disease (GERD) is frequently managed by primary-care physicians (PCPs) although little is known about their current practices and management patterns.
We administered a questionnaire-based survey to PCPs attending sponsored educational conferences on GERD. Questionnaires were completed anonymously before the conferences and asked about prescribing patterns, indications for surgical referral, and issues concerning Barrett's esophagus and H. pylori infection.
A total of 1046 completed questionnaires (97% acceptance rate) were received. Most PCPs prescribed a proton pump inhibitor (PPI) for GERD without prior authorization and without first using an H2-receptor antagonist (H2RA). Many gave an H2RA with once-daily PPI treatment for patients with nocturnal heartburn. Most referrals for anti-reflux surgery were for inadequate response to medical treatment, although PCPs usually first sought gastroenterological consultation. There was a widespread acceptance of screening GERD patients for Barrett's esophagus. There was general confusion about any relationship between H. pylori infection and GERD; 80% of PCPs tested for the infection in at least some patients who only had symptoms of GERD.
Our survey has identified a number of areas of controversy and confusion related to the management of GERD. We hope that our findings can assist in the development of educational materials on GERD for PCPs.
尽管对于基层医疗医生（PCP）目前的诊疗实践和管理模式知之甚少，但胃食管反流病（GERD）常常由他们进行管理。
我们对参加GERD相关教育会议的基层医疗医生进行了问卷调查。问卷在会议前匿名填写，内容涉及处方模式、手术转诊指征以及与巴雷特食管和幽门螺杆菌感染相关的问题。
共收到1046份完整问卷（接受率为97%）。大多数基层医疗医生在未事先获批且未首先使用H2受体拮抗剂（H2RA）的情况下就为GERD患者开具质子泵抑制剂（PPI）。许多医生会为夜间烧心的患者给予H2RA联合每日一次的PPI治疗。大多数抗反流手术转诊是因为药物治疗效果不佳，尽管基层医疗医生通常会首先寻求胃肠病学会诊。对GERD患者进行巴雷特食管筛查得到了广泛认可。对于幽门螺杆菌感染与GERD之间的关系普遍存在困惑；80%的基层医疗医生至少会对一些仅有GERD症状的患者进行该感染的检测。
我们的调查确定了一些与GERD管理相关的争议和困惑领域。我们希望我们的研究结果能够有助于为基层医疗医生开发GERD相关的教育材料。
