Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Primary Care Education Consortium, Winnsboro, Texas, USA.
BMJ Open Gastroenterol. 2022 Jul;9(1). doi: 10.1136/bmjgast-2022-000941.
Management of erosive oesophagitis (EE) remains suboptimal, with many patients experiencing incomplete healing, ongoing symptoms, and relapse despite proton pump inhibitor (PPI) treatment. The Study of Acid-Related Disorders investigated patient burden of individuals with EE in a real-world setting.
US gastroenterologists (GIs) or family physicians (FPs)/general practitioners (GPs) treating patients with EE completed a physician survey and enrolled up to four patients with EE for a patient survey, with prespecified data extracted from medical records.
102 GIs and 149 FPs/GPs completed the survey; data were available for 73 patients (mean age at diagnosis, 45.4 years). Omeprazole was healthcare professional (HCP)-preferred first-line treatment (60.8% GIs; 56.4% FPs/GPs), and pantoprazole preferred second line (29.4% and 32.9%, respectively). Price and insurance coverage (both 55.5% HCPs) and familiarity (47.9%) key drivers for omeprazole; insurance coverage (52.0%), price (50.0%), familiarity (48.0%), initial symptom relief (46.0%), and safety (44.0%) key drivers for pantoprazole. Only 49.3% patients took medication as instructed all the time; 56.8% independently increased medication frequency some of the time. Despite treatment, 57.5% patients experienced heartburn and 30.1% regurgitation; heartburn was the most bothersome symptom. 58.9% patients believed that their symptoms could be better controlled; only 28.3% HCPs were very satisfied with current treatment options. 83.6% patients wanted long-lasting treatment options. Fast symptom relief for patients was a top priority for 66.1% HCPs, while 56.6% would welcome alternatives to PPIs.
This real-world multicentre study highlights the need for new, rapidly acting treatments in EE that reduce symptom burden, offer durable healing and provide symptom control.
尽管质子泵抑制剂 (PPI) 治疗可使多数患者的食管侵蚀性食管炎 (EE) 愈合不完全，但仍存在许多患者持续存在症状和复发的情况，因此 EE 的管理仍不理想。酸相关疾病研究在真实环境中调查了 EE 患者的个体负担。
治疗 EE 患者的美国胃肠病学家 (GI) 或家庭医生 (FP)/全科医生 (GP) 完成了一项医生调查，并为每位 EE 患者招募了最多 4 名患者进行患者调查，从病历中提取了预设数据。
102 名 GI 和 149 名 FP/GP 完成了调查；73 名患者的数据可用（诊断时的平均年龄为 45.4 岁）。奥美拉唑是医疗保健专业人员 (HCP) 首选的一线治疗药物（60.8%的 GI；56.4%的 FP/GP），而泮托拉唑则是首选二线药物（分别为 29.4%和 32.9%）。价格和保险覆盖范围（HCP 均为 55.5%）和熟悉程度（47.9%）是奥美拉唑的关键驱动因素；保险覆盖范围（52.0%）、价格（50.0%）、熟悉程度（48.0%）、初始症状缓解（46.0%）和安全性（44.0%）是泮托拉唑的关键驱动因素。只有 49.3%的患者始终按照医嘱服药；56.8%的患者有时会自行增加药物使用频率。尽管进行了治疗，但仍有 57.5%的患者出现烧心，30.1%的患者出现反流；烧心是最恼人的症状。58.9%的患者认为他们的症状可以得到更好的控制；只有 28.3%的 HCP 对当前的治疗选择非常满意。83.6%的患者希望获得持久的治疗选择。快速缓解患者的症状是 66.1%的 HCP 的首要任务，而 56.6%的 HCP 则欢迎替代 PPI 的方案。
这项真实世界的多中心研究强调了 EE 中需要新的、起效迅速的治疗方法，这些方法可以减轻症状负担，提供持久的愈合，并控制症状。
