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首页> 外文期刊>Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery >The challenge of protocols for reflux disease: a review and development of a critical pathway.
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The challenge of protocols for reflux disease: a review and development of a critical pathway.

机译：返流性疾病方案的挑战：关键途径的回顾和发展。

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OBJECTIVES: Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) are very common and controversial diseases. The authors have previously reviewed clinical practice guidelines (CPGs) on reflux disease, and these major consensus statements differ on what constitutes ideal management. The aim is to critically review existing protocols for reflux based on CPG recommendations and to present a refined protocol that may be further used to develop a critical pathway for reflux in ambulatory medical practice. STUDY DESIGN: Literature review with discussion. METHODS: A PubMed search was used to identify current clinical protocols or algorithms for reflux disease, and the principal elements of each were compared. RESULTS: Of the 828 articles identified in the search, 11 met the search criteria. Together with 4 articles previously identified, 15 were analyzed. All protocols discuss the important role of empiric therapy, although with differences in use. Only 5 protocols (33%) were based on systematic review such as CPGs. Eight protocols (53%) used alarm symptoms to prompt a workup. For these patients, upper endoscopy was by far the most common diagnostic method. The use of other modalities varies significantly between protocols. The authors propose a standard protocol based on patient risk factors that employs CPG recommendations and may be used for critical pathway outcomes measures. CONCLUSION: There are major differences between existing protocols for reflux disease in the literature, reflecting many clinical controversies. Outcomes of different protocols have not been extensively studied. The authors propose a new protocol that is a synthesis of those reviewed and based on risk stratification.
机译：目的：胃食管反流病（GERD）和喉咽反流病（LPR）是非常常见且有争议的疾病。作者之前已经回顾了关于反流疾病的临床实践指南（CPG），并且这些主要的共识性声明在构成理想治疗方法方面存在差异。目的是根据CPG的建议严格审查现有的反流方案，并提出一种完善的方案，可将其进一步用于发展非卧床医疗实践中的反流关键途径。研究设计：文献复习和讨论。方法：使用PubMed搜索来识别当前反流疾病的临床方案或算法，并比较每种方案的主要成分。结果：在搜索中确定的828篇文章中，有11篇符合搜索条件。连同之前确定的4篇文章，共分析了15篇。尽管使用方法不同，但所有协议都讨论了经验疗法的重要作用。只有5项规程（33％）是基于系统评价（例如CPG）。八个协议（53％）使用警报症状来提示进行检查。对于这些患者，上内镜检查是迄今为止最常见的诊断方法。协议之间其他方式的使用差异很大。作者提出了一种基于患者危险因素的标准方案，该方案采用了CPG建议，可用于关键途径结局指标。结论：文献中现有的反流疾病治疗方案之间存在主要差异，反映出许多临床争议。尚未广泛研究不同协议的结果。作者提出了一种新的协议，该协议是根据风险分层对已审查者进行综合的。

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