Primary Care and General Practice, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
Department of Health Sciences, United Campus of Malta, Msida, Malta.
Aliment Pharmacol Ther. 2022 Jun;55(12):1492-1500. doi: 10.1111/apt.16930. Epub 2022 Apr 22.
Despite widespread adoption of potent acid suppression treatment with proton pump inhibitors (PPI) for reflux-like symptoms, persistent symptoms are commonly reported in primary care and community studies.
This multidisciplinary review critically evaluates how the management of reflux-like symptoms could better reflect their multifactorial pathophysiology.
A panel of experts (from general practice, gastroenterology and gastropsychology) attended a series of workshops to review current management and propose a framework for the provision of more individualised care.
It was agreed that the perceptual (as well as the physiological) causes of reflux-like symptoms should be considered at the start of management, not as a last resort when all else has failed. A short course of PPI is a pragmatic approach to address reflux-like symptoms, but equally important is counselling about the gut-brain axis and provision of symptom-specific behavioural interventions for those who show signs of somatisation, hypervigilance or co-existing disorders of gut-brain interaction. Other low-harm interventions such as lifestyle and dietary advice, should also be better integrated into care at an early stage. Multidisciplinary care management programmes (including dietary, weight loss, exercise and behavioural intervention) should be developed to promote greater self-management and take advantage of the general shift toward the use of remotely accessed health care resources.
Management of reflux-like symptoms should be adapted to reflect the advances in knowledge about the multifactorial aetiology of these symptoms, addressing both acid-related and behavioural components early in management. The time has come to treat the patient, not the "disease".
尽管质子泵抑制剂 (PPI) 等强效抑酸治疗被广泛用于治疗反流样症状，但在初级保健和社区研究中，仍常报告持续存在的症状。
本多学科综述批判性地评估了如何更好地反映反流样症状的多因素病理生理学，从而改善其管理。
一组专家（来自普通科、肠胃科和肠胃心理学）参加了一系列研讨会，以审查当前的管理方法，并提出一个更个性化的护理框架。
与会者一致认为，应在管理开始时考虑反流样症状的感知（以及生理）原因，而不是在所有其他方法都失败时才考虑。短期 PPI 治疗是解决反流样症状的一种实用方法，但同样重要的是，应向那些有躯体化、过度警觉或共存的肠脑互动障碍迹象的患者提供有关肠脑轴的咨询，并提供针对症状的行为干预。对于那些有躯体化、过度警觉或共存的肠脑互动障碍迹象的患者，还应更好地将其他低伤害干预措施（如生活方式和饮食建议）纳入早期护理中。应制定多学科护理管理方案（包括饮食、减肥、锻炼和行为干预），以促进更好的自我管理，并利用向远程获取医疗保健资源转变的机会。
应调整反流样症状的管理方法，以反映这些症状多因素病因方面的知识进展，在管理早期同时解决与酸相关和行为相关的因素。现在是“治疗患者，而非‘疾病’”的时候了。
