夜间胃食管反流病管理的真实世界临床实践模式：来自全国性RELIEF调查的见解

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中文摘要

背景与目的： 胃食管反流病（GERD）的夜间症状会干扰日间功能、工作和社会活动，从而对健康相关生活质量产生负面影响。因此，本调查旨在评估印度夜间GERD管理的临床实践模式。
方法： 在印度各地从事胃肠病学实践的医疗保健从业者（HCP）中开展了一项基于数字问卷的全国性RELIEF调查。医生根据其临床经验自愿回答由24个问题组成的调查问卷。收集完整问卷后，对数据进行了审查和分析。
结果： 在接触的500名HCP中，498名完成了研究。GERD每月占患者负担的>30%。根据25.30%的HCP，21-30%的GERD患者主诉夜间症状。夜间GERD患者最常见的危险因素是深夜进食（67.67%），其次是吸烟（51%）、BMI>25 kg/m2（50.20%）和高脂饮食（50.40%）。大多数HCP（83%）依靠症状和病史来诊断夜间GERD。单剂量质子泵抑制剂（PPI）方案是最首选的治疗，31.53%的HCP报告采用，其中54%的医生偏好埃索美拉唑。疗效（58.03%）、最少或无药物相互作用（29.92%）和成本（22.49%）是选择PPI的重要方面。HCP（63.18%）选择4-8周的PPI治疗以实现夜间GERD症状的缓解，随后进行3-6个月的维持治疗（57.95%）。80.72%的HCP报告的PPI不依从常见原因是症状改善后停止治疗（53.01%）、成本（39.56%）和疾病认知不完整（29.92%）。大多数HCP（42.77%）报告使用PPI无副作用。
结论： 该调查强调了印度夜间GERD管理的关键见解，近四分之一的GERD患者报告有烧心和反流等夜间症状，强调需要生活方式调整和合适的药物干预。管理策略主要包括PPI治疗，埃索美拉唑是夜间GERD的首选。

英文摘要

BACKGROUND AND OBJECTIVES: Nocturnal symptoms of GERD interfere with daytime functioning, work, and social activities, thereby negatively affecting health-related quality of life. Therefore, the present survey aimed to evaluate the clinical practice patterns regarding the management of nocturnal GERD in India.
METHODS: A digital questionnaire-based nationwide RELIEF survey was conducted among health care practitioners (HCPs) with gastroenterology practice across India. Physicians voluntarily responded to the survey questionnaire consisting of 24 questions based on their clinical experience. Following the collection of completed questionnaires, data were reviewed and analyzed.
RESULTS: Of the 500 HCPs who were approached, 498 completed the study. GERD contributed to > 30% of patient burden every month. According to 25.30% of HCPs, 21-30% of patients with GERD complain of nocturnal symptoms. The most common risk factors in patients with nocturnal GERD were late-night meals (67.67%), followed by smoking (51%), BMI > 25 kg/m2 (50.20%), and a high-fat diet (50.40%). Most HCPs (83%) relied on symptoms and medical history to diagnose nocturnal GERD. A single-dose proton pump inhibitor (PPI) regimen was the most preferred treatment, reported by 31.53% of HCPs, with esomeprazole preferred by 54% of physicians. Efficacy (58.03%), minimum or no drug-drug interactions (29.92%), and cost (22.49%) are the important aspects for choosing a PPI. HCPs (63.18%) opted for 4-8 weeks of PPI therapy to achieve resolution of nocturnal GERD symptoms, followed by 3-6 months of maintenance therapy (57.95%). Common causes of non-adherence to PPIs, as reported by 80.72% of HCPs, were stopping treatment once symptoms improved (53.01%), cost (39.56%), and incomplete disease awareness (29.92%). Most of the HCPs (42.77%) reported no side effects with the use of PPIs.
CONCLUSION: The survey highlighted key insights into managing nocturnal GERD in India, with nearly one-fourth of GERD patients reporting nocturnal symptoms like heartburn and regurgitation, emphasizing the need for lifestyle modifications and suitable pharmacological interventions. The management strategy primarily includes PPI therapy, with esomeprazole being the preferred choice for nocturnal GERD.