Lata Tahmina, Trautman Jodie, Townend Philip, Wilson Robert B
Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.
Upper Gastrointestinal Surgery Department, University of New South Wales, Liverpool Hospital, Liverpool, NSW, Australia.
Gastroenterol Rep (Oxf). 2023 Apr 18;11:goad008. doi: 10.1093/gastro/goad008. eCollection 2023.
The purpose of this study was to review the current management of gastro-oesophageal reflux disease (GORD), including treatment costs, safety profile and effectiveness.
A literature review was performed of randomized-controlled trials, systematic reviews, Cochrane reports and National/Societal guidelines of the medical, endoscopic and surgical management of GORD. Proton pump inhibitor (PPI) prescribing patterns and expenditure were reviewed in different countries, including Australia, Canada, New Zealand, UK and USA.
Proton pump inhibitors (PPIs) are primarily indicated for control of GORD, Helicobacter pylori eradication (combined with antibiotics), preventing NSAID-induced gastrointestinal bleeding and treating peptic ulcer disease. There is widespread overprescribing of PPIs in Western and Eastern nations in terms of indication and duration, with substantial expense for national health providers. Despite a favourable short-term safety profile, there are observational associations of adverse effects with long-term PPIs. These include nutrient malabsorption, enteric infections and cardiovascular events. The prevalence of PPI use makes their long-term safety profile clinically relevant. Cost-benefit, symptom control and quality-of-life outcomes favour laparoscopic fundoplication rather than chronic PPI treatment. Laparoscopic fundoplication in long-term management of PPI-responsive GORD is supported by SAGES, NICE and ACG, and PPI-refractory GORD by AGA and SAGES guidelines. The importance of establishing a definitive diagnosis prior to invasive management is emphasized, especially in PPI-refractory heartburn.
We examined evidence-based guidelines for PPI prescribing and deprescribing in primary care and hospital settings and the need for PPI stewardship and education of health professionals. This narrative review presents the advantages and disadvantages of surgical, endoscopic and medical management of GORD, which may assist in shared decision making and treatment choice in individual patients.This paper was presented (GS020) at the 88th RACS Annual Scientific Conference, 6-10 May, 2019.
本研究旨在回顾胃食管反流病（GORD）的当前管理情况，包括治疗成本、安全性和有效性。
对GORD的药物、内镜和手术管理的随机对照试验、系统评价、Cochrane报告以及国家/社会指南进行了文献综述。回顾了澳大利亚、加拿大、新西兰、英国和美国等不同国家质子泵抑制剂（PPI）的处方模式和支出情况。
质子泵抑制剂（PPI）主要用于控制GORD、根除幽门螺杆菌（与抗生素联合使用）、预防非甾体抗炎药引起的胃肠道出血以及治疗消化性溃疡病。在西方国家和东方国家，PPI在适应证和用药时长方面都存在广泛的过度处方现象，给国家卫生服务机构带来了巨大费用。尽管PPI短期安全性良好，但长期使用存在一些不良反应的观察性关联。这些不良反应包括营养吸收不良、肠道感染和心血管事件。PPI的广泛使用使得其长期安全性在临床上具有重要意义。成本效益、症状控制和生活质量结果表明，腹腔镜胃底折叠术优于长期PPI治疗。SAGES、NICE和ACG支持腹腔镜胃底折叠术用于PPI反应性GORD的长期管理，AGA和SAGES指南支持其用于PPI难治性GORD的治疗。强调了在进行侵入性治疗前明确诊断的重要性，尤其是在PPI难治性烧心患者中。
我们研究了基层医疗和医院环境中PPI处方和停用的循证指南，以及PPI管理和对卫生专业人员进行教育的必要性。本叙述性综述介绍了GORD手术、内镜和药物治疗的优缺点，这可能有助于个体患者的共同决策和治疗选择。本文于2019年5月6 - 10日在第88届RACS年度科学会议上发表（GS020）。
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