PMID- 35460095
OWN - NLM
STAT- MEDLINE
DCOM- 20220526
LR  - 20220731
IS  - 1365-2036 (Electronic)
IS  - 0269-2813 (Print)
IS  - 0269-2813 (Linking)
VI  - 55
IP  - 12
DP  - 2022 Jun
TI  - Review article: rethinking the "ladder" approach to reflux-like symptom 
      management in the era of PPI "resistance" - a multidisciplinary perspective.
PG  - 1492-1500
LID - 10.1111/apt.16930 [doi]
AB  - BACKGROUND: 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. AIMS: This 
      multidisciplinary review critically evaluates how the management of reflux-like 
      symptoms could better reflect their multifactorial pathophysiology. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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".
CI  - (c) 2022 The Authors. Alimentary Pharmacology & Therapeutics published by John 
      Wiley & Sons Ltd.
FAU - Hungin, A Pali S
AU  - Hungin APS
AUID- ORCID: 0000-0001-7275-8927
AD  - Primary Care and General Practice, Faculty of Medical Sciences, Newcastle 
      University, Newcastle upon Tyne, UK.
FAU - Scarpignato, Carmelo
AU  - Scarpignato C
AD  - Department of Health Sciences, United Campus of Malta, Msida, Malta.
FAU - Keefer, Laurie
AU  - Keefer L
AD  - Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
FAU - Corsetti, Maura
AU  - Corsetti M
AUID- ORCID: 0000-0003-2957-4684
AD  - NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS 
      Trust, Nottingham, UK.
AD  - School of Medicine, University of Nottingham and Translational Medical Science - 
      Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK.
FAU - Anastasiou, Foteini
AU  - Anastasiou F
AD  - 4th Local Primary Care Team, Municipality Practice and Academic Practice of 
      Heraklion, Crete, Greece.
FAU - Muris, Jean W M
AU  - Muris JWM
AD  - Department of Family Medicine, Care and Public Health Research Institute 
      (CAPHRI), Maastricht University, Maastricht, The Netherlands.
FAU - Mendive, Juan M
AU  - Mendive JM
AD  - La Mina Primary Care Academic Centre, Catalan Health Institute, University of 
      Barcelona, Barcelona, Spain.
FAU - Kahrilas, Peter J
AU  - Kahrilas PJ
AD  - Division of Gastroenterology, Feinberg School of Medicine, Northwestern 
      University, Chicago, Illinois, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20220422
PL  - England
TA  - Aliment Pharmacol Ther
JT  - Alimentary pharmacology & therapeutics
JID - 8707234
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - *Gastroesophageal Reflux/complications/diagnosis/drug therapy
MH  - *General Practice
MH  - Humans
MH  - Life Style
MH  - Proton Pump Inhibitors/therapeutic use
PMC - PMC9324949
EDAT- 2022/04/24 06:00
MHDA- 2022/05/27 06:00
PMCR- 2022/07/26
CRDT- 2022/04/23 05:25
PHST- 2021/01/26 00:00 [revised]
PHST- 2021/12/07 00:00 [received]
PHST- 2022/04/03 00:00 [accepted]
PHST- 2022/04/24 06:00 [pubmed]
PHST- 2022/05/27 06:00 [medline]
PHST- 2022/04/23 05:25 [entrez]
PHST- 2022/07/26 00:00 [pmc-release]
AID - APT16930 [pii]
AID - 10.1111/apt.16930 [doi]
PST - ppublish
SO  - Aliment Pharmacol Ther. 2022 Jun;55(12):1492-1500. doi: 10.1111/apt.16930. Epub 
      2022 Apr 22.