Gastric reflux management at primary care level

Abstract

Gastroesophageal Reflux (GER) is a common disease; if associated with oesophageal damage is named GER disease (GERD) or if it damages upper airways as laryngopharyngeal Reflux (LPR). Although gastric reflux is common, its management remains challenging at the primary care level. The current experience evaluated the impact of an educational project about gastric reflux on the prescriptive attitude of primary care doctors. A large group of patients (20,778) with gastric reflux symptoms was evaluated before and after the educational program, involving 708 Italian physicians working at the primary care level. Before the update, only one-quarter of patients were actively treated for gastric reflux problems. The most common medications were PPI (72%), alginates (40%), and antacids (33%). A monotherapy was more frequently prescribed than polytherapy. After the educational program, 71% of patients had GERD diagnosis, and 29% LPR. In addition, 84% of patients had a medical prescription for harmful gastric reflux. Polytherapy was prescribed in 9,422 patients, mainly using PPI as an add-on associated with alginates, prokinetics, or antacids. Monotherapy was used in 8,069 patients, alginates were prescribed in 52% of patients, PPI in 28.6%, and antacids in 9.4%. In conclusion, the current experience confirmed the worth of continuing medical education and the importance of correctly managing patients with gastric reflux concerns. GERD and LPR should be adequately treated using appropriate medications, mainly concerning alginates and PPI.