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

Abstract

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 patient-centered approach to GERD management and better communication between patients and providers. Shared decision making (SDM) with the incorporation of patient-reported outcomes (PRO) promotes patient adherence and satisfaction. SDM is a joint discussion between clinician and patient in which a mutually shared solution is explored for GERD symptoms. For SDM to work the physician needs to capture patients’ perceptions which may not be obtained in the standard interview. This can be done through the use of PROs which promote a dialogue with patients about their symptoms and treatment priorities in the context of the SDM patient encounter. SDM could potentially help in the management of patient expectations for GERD treatment, ultimately positively impacting their health-related quality of life.

Reflux Symptoms – Functional and Structural Diseases: The Approach from the General Practitioner

“…In addition, GPs underestimated residual symptom severity compared with their patients, suggesting the need for better communication [23]. Better GP-patient communication and shared decision-making could improve patient-reported outcomes and patient satisfaction in GERD [24].…”

Avaliação da relação entre a doença do refluxo gastroesofágico, tabagismo e desgastes dentais: revisão narrativa da literatura

“…Episódios leves e pós-prandiais de refluxo podem ocorrer de forma fisiológica e assintomática, mas quando causam sintomas e/ou complicações, a condição se torna patológica e recebe o nome de DRGE (Moraes-Filho, 2004;Richter, 1996;Vakil et al, 2006). Os sintomas mais comuns são queimação retroesternal (pirose) e regurgitação, podendo a doença se manifestar de maneira mais inespecífica, por tosse, náusea e rouquidão (Klenzak et al, 2018). Todo esse contexto patológico pode impactar profundamente o bem estar e a qualidade de vida, prejudicando o sono e afetando a saúde física e mental do indivíduo (Tack et al, 2012;Wiklund, 2004).…”

Knowledge and practice of family medicine and internal medicine residents toward the management of gastroesophageal reflux disease in Riyadh, Saudi Arabia

“…Despite the availability of clear guidelines for GERD management,[ 10 11 ] accurate diagnosis and GERD management in primary care settings remain a challenge. [ 12 13 ] There are inherent limitations of both symptom-based and investigation-based approaches of diagnosis. [ 13 ] Additionally, there is usually disagreement between a physician and patient regarding the disease severity, treatment outcome, and the impact on quality of life.…”