Management of gastroesophageal reflux disease: Patient and physician communication challenges and shared decision making

作者：Scott Klenzak, Igor Danelisen, Grace D. Brannan, Melissa A. Holland, Miranda A.L. van Tilburg · 发表于：World Journal of Clinical Cases · 年份：2018 · DOI：10.12998/wjcc.v6.i15.892 · 被引用次数：19 · 研究领域：Gastroesophageal reflux and treatments、Eosinophilic Esophagitis、Helicobacter pylori-related gastroenterology studies

Gastroesophageal reflux disease (GERD) is a common upper esophageal condition and typical symptoms can include heartburn and sensation of regurgitation while atypical symptoms include chronic cough, asthma, hoarseness, dyspepsia and nausea. Typically, diagnosis is presumptive given the presence of typical and atypical symptoms and is an indication for empiric therapy. Treatment management can include lifestyle modifications and/or medication therapy with proton pump inhibitor (PPI) class being the preferred and most effective. Complete symptom resolution is not always achieved and long-term PPI therapy can put patients at risk for serious side effects and needless expense. The brain-gut connection and hypervigilance plays an important role in symptom resolution and treatment success, especially in the case of non-PPI responders. Hypervigilance is a combination of increased esophageal sensory sensitivity in combination with exaggerated threat perception surrounding esophageal symptoms. Hypervigilance requires a different approach to GERD managements, where continued PPI therapy and surgery are usually not recommended. Rather, helping physicians and patients understand the brain-gut connection can guide and improve care. Education and reassurance should be the main pillars or treatment. However, it is important not to suggest the symptoms are due to anxiety alone, this often leads to patient dissatisfaction. Patient dissatisfaction with treatment reveals the need for a more pat...