The Proton Pump Inhibitor Nonresponder: a Behavioral Approach to Improvement and Wellness.
The Proton Pump Inhibitor Nonresponder: a Behavioral Approach to Improvement and Wellness.
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DOI：
10.1007/s11894-018-0641-x
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发表时间：
2018-06-09
影响因子：
--
通讯作者：
Chen, Joan W
中科院分区：
文献类型：
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作者：
Riehl, Megan E;Chen, Joan W
回顾目的：胃食管反流病（GERD）是一种难以治疗的疾病，其中近40%的患者对标准药物干预难以治愈，通常从质子泵抑制剂（PPI）开始。这些PPI无应答者代表了患者群体，治疗计划必须个体化；应考虑多学科和精神合并症。这篇综述强调了治疗选择，包括神经调节剂、生活方式和心理干预的PPI无反应。最近发现：心理胃肠病学领域的心理健康专家可以帮助管理食管超敏反应，这可以驱动PPI无反应的症状体验。考虑到这一人群的共病焦虑和抑郁需要仔细的评估和治疗。鼓励医生为症状管理创造现实的期望，并在护理早期提供多学科治疗方案。患者通常会受益于胃肠道心理学家的工作，并发现行为干预的价值。
PURPOSE OF REVIEW: Gastroesophageal reflux disease (GERD) is a difficult to treat medical condition, where nearly 40% of patients are refractory to standard medical intervention, which typically begins with a proton pump inhibitor (PPI). These PPI nonresponders represent a population of patients, where treatment planning must be individualized; multidisciplinary and psychiatric comorbidities should be considered. This review highlights treatment options that include neuromodulators, lifestyle, and psychological interventions for the PPI nonresponder.RECENT FINDINGS: Mental health specialists in the field of psychogastroenterology can aid in the management of esophageal hypersensitivity, which can drive the symptom experience of a PPI nonresponder. Considerations for comorbid anxiety and depression in this population require careful assessment and treatment. Physicians are encouraged to create realistic expectations for symptom management and offer multidisciplinary options for treatment early in care. Patients will frequently benefit from working with a GI psychologist and find value in behavioral interventions.