Comparative Effectiveness of Management Strategies for Gastroesophageal Reflux Disease PDF Download
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Languages : en
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BACKGROUND: Gastroesophageal reflux disease (GERD) is one of the most common health conditions affecting Americans. Despite the availability of medical, surgical, and endoscopic options, optimal management strategies remain unsettled. PURPOSE: The purpose was to systematically review and update our previous Comparative Effectiveness Review, which compared the effectiveness of different management options for adults with GERD. DATA SOURCES: We searched MEDLINE, (r) Cochrane Central Register of Controlled Trials, and other relevant databases, as well as other existing systematic reviews. STUDY SELECTION: Studies of various designs were sought, including comparative randomized controlled trials, nonrandomized and cohort studies, and systematic reviews. DATA EXTRACTION: A standardized protocol was used to extract details on study design, diagnoses, interventions, outcomes, and quality. DATA SYNTHESIS: In total, 166 studies met eligibility criteria. We found a moderate strength of evidence that laparoscopic fundoplication in patients whose GERD symptoms were already well controlled by medical treatments was at least as effective as continued medical treatment (and in some cases superior) in controlling GERD-related symptoms for the first 1 to 3 years following surgery. However, the rate of serious adverse events was generally higher in patients who underwent fundoplication compared with those who had medical treatment. We did not identify sufficient evidence to conclude whether medical or surgical treatment was more effective in preventing long-term complications of GERD, such as the development of Barrett's esophagus or esophageal adenocarcinoma. We found a moderate strength of evidence that proton pump inhibitors were superior to histamine-2 receptor antagonists in resolving GERD symptoms at 4 weeks and promoting healing of esophagitis at 8 weeks. Evidence regarding the effectiveness of endoscopic procedures was insufficient. Evidence regarding the effectiveness of treatment of GERD on asthma symptoms was inconclusive. LIMITATIONS: Studies directly comparing surgery to medical therapy generally had high dropout rates in long-term followup. There was a great deal of variability in the rigor with which the outcomes were evaluated across studies, particularly in subjective endpoints. CONCLUSIONS: Medical therapy and laparoscopic fundoplication were similarly effective in improving GERD symptoms in patients whose symptoms were already well controlled by medical therapy for at least the first 1 to 3 years following surgery. Serious adverse events were more common after surgery. The effectiveness of endoscopic procedures remains substantially uncertain.
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Publisher:
ISBN:
Category :
Languages : en
Pages :
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Book Description
BACKGROUND: Gastroesophageal reflux disease (GERD) is one of the most common health conditions affecting Americans. Despite the availability of medical, surgical, and endoscopic options, optimal management strategies remain unsettled. PURPOSE: The purpose was to systematically review and update our previous Comparative Effectiveness Review, which compared the effectiveness of different management options for adults with GERD. DATA SOURCES: We searched MEDLINE, (r) Cochrane Central Register of Controlled Trials, and other relevant databases, as well as other existing systematic reviews. STUDY SELECTION: Studies of various designs were sought, including comparative randomized controlled trials, nonrandomized and cohort studies, and systematic reviews. DATA EXTRACTION: A standardized protocol was used to extract details on study design, diagnoses, interventions, outcomes, and quality. DATA SYNTHESIS: In total, 166 studies met eligibility criteria. We found a moderate strength of evidence that laparoscopic fundoplication in patients whose GERD symptoms were already well controlled by medical treatments was at least as effective as continued medical treatment (and in some cases superior) in controlling GERD-related symptoms for the first 1 to 3 years following surgery. However, the rate of serious adverse events was generally higher in patients who underwent fundoplication compared with those who had medical treatment. We did not identify sufficient evidence to conclude whether medical or surgical treatment was more effective in preventing long-term complications of GERD, such as the development of Barrett's esophagus or esophageal adenocarcinoma. We found a moderate strength of evidence that proton pump inhibitors were superior to histamine-2 receptor antagonists in resolving GERD symptoms at 4 weeks and promoting healing of esophagitis at 8 weeks. Evidence regarding the effectiveness of endoscopic procedures was insufficient. Evidence regarding the effectiveness of treatment of GERD on asthma symptoms was inconclusive. LIMITATIONS: Studies directly comparing surgery to medical therapy generally had high dropout rates in long-term followup. There was a great deal of variability in the rigor with which the outcomes were evaluated across studies, particularly in subjective endpoints. CONCLUSIONS: Medical therapy and laparoscopic fundoplication were similarly effective in improving GERD symptoms in patients whose symptoms were already well controlled by medical therapy for at least the first 1 to 3 years following surgery. Serious adverse events were more common after surgery. The effectiveness of endoscopic procedures remains substantially uncertain.
Author: U. S. Department of Health and Human Services
Publisher: CreateSpace
ISBN: 9781484054802
Category : Medical
Languages : en
Pages : 244
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Book Description
Gastroesophageal reflux disease (GERD) is one of the most common health conditions affecting Americans. A study of an employed population in the U.S. estimated that more than 11,000 of 267,000 employees (4 %) suffered from GERD, contributing an average incremental cost to the employer of $3,355 per employee during a 3-year observation period—approximately 65 % related to prescription drugs. At the same time, it is well recognized that some drugs used to treat GERD (such as proton pump inhibitors) are overprescribed. A number of patients have frequent severe symptoms requiring long-term regular use of antireflux medications. For these individuals with chronic GERD, most authorities consider the goals of therapy to be an improvement in symptoms and quality of life, healing and maintenance of healed erosive esophagitis, and prevention of complications. However, there remains considerable uncertainty regarding how these objectives should be achieved. Among patients treated medically, several approaches are used, depending in part on the severity of symptoms and clinical response. These include intermittent, periodic, or continuous use of prescription or over-the-counter medications, especially histamine type 2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs). The availability of surgery and, more recently, endoscopic treatments has further complicated the choice among management strategies. The first Comparative Effectiveness Review (CER) published by the AHRQ focused on GERD. Key Questions addressed in that report concerned the comparative effectiveness of medical, surgical, and endoscopic treatments for improving objective and subjective outcomes in patients with this disease. The report also examined the relative efficacy of these interventions in specific patient subgroups as well as adverse event profiles. A number of developments since the publication of the 2005 review have necessitated an update. Among them are the publication of approx. 3,000 new studies; the introduction of novel drugs; the recognition of new drug safety considerations; and the withdrawal of previously approved endoscopic interventions and introduction of new endoscopic interventions. Also notable was the publication of a new consensus definition of GERD in 2006. The current report addresses developments in the treatment of GERD in adults and additionally includes sections on treatment of extraesophageal syndromes, including chronic cough, laryngitis, and asthma, which an expert panel considered to be of particular clinical importance. Key Questions in this review include: KQ1. What is the evidence of the comparative effectiveness of medical, surgical, and other newer forms of treatments for improving objective and subjective outcomes in patients with chronic GERD? Is there evidence that effectiveness varies by specific technique, procedure, or medication? Objective outcomes addressed include esophagitis healing, ambulatory pH, other indicators of reflux, need for medication, health care utilization, and incidence of esophageal stricture, Barrett's esophagus, or esophageal adenocarcinoma. Subjective outcomes include symptom frequency and severity, sleep/productivity, and overall quality of life. KQ2. Is there evidence that effectiveness of medical, surgical, and newer forms of treatments varies for specific patient subgroups? What are the characteristics of patients who have undergone these therapies, including the nature of previous medical therapy, severity of symptoms, age, sex, weight, and other demographic and medical factors? What are the provider characteristics for procedures, including provider volume and setting (e.g., academic vs. community)? KQ3. What are the short-term and long-term adverse events associated with specific medical, surgical, and other newer forms of therapies for GERD? Does the incidence of adverse events vary with duration of followup, specific surgical intervention, or patient characteristics?
Author: Stanley Ip
Publisher:
ISBN:
Category :
Languages : en
Pages : 100
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Book Description
This report examines alternatives for managing the chronic symptoms of uncomplicated gastroesophageal reflux disease (GERD) in patients who may require long-term treatment. It summarizes the available evidence comparing the efficacy and safety of medical, surgical, and endoscopic interventions in the treatment of chronic GERD, particularly after long-term followup. Questions addressed in this report are: 1) What is the evidence of the comparative effectiveness of medical, surgical, and endoscopic treatments for improving objective and subjective outcomes in patients with chronic GERD? 2) Is there evidence that effectiveness of medical, surgical, and endoscopic treatments varies for specific patient subgroups? 3) What are the short- and long-term adverse effects associated with specific medical, surgical, and endoscopic therapies for GERD?
Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309138361
Category : Medical
Languages : en
Pages : 252
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Book Description
Clinical research presents health care providers with information on the natural history and clinical presentations of disease as well as diagnostic and treatment options. In today's healthcare system, patients, physicians, clinicians and family caregivers often lack the sufficient scientific data and evidence they need to determine the best course of treatment for the patients' medical conditions. Initial National Priorities for Comparative Effectiveness Research(CER) is designed to fill this knowledge gap by assisting patients and healthcare providers across diverse settings in making more informed decisions. In this 2009 report, the Institute of Medicine's Committee on Comparative Effectiveness Research Prioritization establishes a working definition of CER, develops a priority list of research topics, and identifies the necessary requirements to support a robust and sustainable CER enterprise. As part of the 2009 American Recovery and Reinvestment Act, Congress appropriated $1.1 billion in federal support of CER, reflecting legislators' belief that better decisions about the use of health care could improve the public's health and reduce the cost of care. The Committee on Comparative Effectiveness Research Prioritization was successful in preparing a list 100 top priority CER topics and 10 recommendations for best practices in the field.
Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309324963
Category : Medical
Languages : en
Pages : 245
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Book Description
Thousands of measures are in use today to assess health and health care in the United States. Although many of these measures provide useful information, their usefulness in either gauging or guiding performance improvement in health and health care is seriously limited by their sheer number, as well as their lack of consistency, compatibility, reliability, focus, and organization. To achieve better health at lower cost, all stakeholders - including health professionals, payers, policy makers, and members of the public - must be alert to what matters most. What are the core measures that will yield the clearest understanding and focus on better health and well-being for Americans? Vital Signs explores the most important issues - healthier people, better quality care, affordable care, and engaged individuals and communities - and specifies a streamlined set of 15 core measures. These measures, if standardized and applied at national, state, local, and institutional levels across the country, will transform the effectiveness, efficiency, and burden of health measurement and help accelerate focus and progress on our highest health priorities. Vital Signs also describes the leadership and activities necessary to refine, apply, maintain, and revise the measures over time, as well as how they can improve the focus and utility of measures outside the core set. If health care is to become more effective and more efficient, sharper attention is required on the elements most important to health and health care. Vital Signs lays the groundwork for the adoption of core measures that, if systematically applied, will yield better health at a lower cost for all Americans.
Author: Joanne K. Singleton
Publisher: Springer Publishing Company
ISBN: 0826171478
Category : Medical
Languages : en
Pages : 1096
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Book Description
Print+CourseSmart
Author: Robert V. DiGregorio, PharmD, BCACP
Publisher: Springer Publishing Company
ISBN: 0826171486
Category : Medical
Languages : en
Pages : 1096
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Book Description
A complete, state-of-the-art bible of interprofessional primary care in one easy-to-use resource for Interprofessional Primary Care A truly interprofessional primary care textbook, created by DNPs/APRNs, MDs, PharmDs, PAs, CNSs, and CNMs Evidence-based practice guidelines for Primary Care Includes community care, team work, and wellness coachings Strong guidance on differential diagnosis, disease prevention, risk reduction and lifestyle management Across the lifespan focus PLUS gender, occupational and palliative care considerations Case Studies in PPT format available to faculty adopting the text This second edition of Primary Care delivers succinct, current, and integrated information on the assessment, differential diagnosis, treatment, and management of individuals with commonly seen conditions in primary care settings. Written and edited by APNs, MDs, PAs, PharmDs and other health professionals, it emphasizes guidance on differential diagnosis, interprofessional primary care, lifestyle management, health promotion, risk reduction, and disease prevention. The text features ërelationship-centered care, extensive coverage of age, gender, and occupational considerations; complementary approaches; nutritional assessment; violence exposure and vulnerability assessment; family, community, and cultural assessment; palliative care; and evidence-based practice guidelines. This important text presents current diagnostic criteria for each condition and includes relevant anatomy, pathology, and physiology, epidemiology of the condition, including cultural and economic factors, risk identification, and disease prevention strategies. Also included are related laboratory studies, the focused physical exam, wellness coaching, treatment options, potential pitfalls, and much more. Additionally, the book includes clinical "pearls", clinical warnings, referrals and warning points, and references. The text is of value to all interprofessional primary care providers, with a special focus on the needs of advanced practice nurses and MSN/DNP students, and as a course textbook for teaching primary health care topics New to the Second Edition: Increased focus on interprofessional primary care, including community care, team work, and wellness coaching Strong guidance on differential diagnosis, disease prevention, risk reduction and lifestyle management Broad team of interprofessional authors and editors Special focus on elder/geriatric primary care and palliative care Evidence-based practice guidelines Stronger focus on age, gender, and occupational considerationsFocus on age, gender, and occupational considerations Case Studies in PPT format available to faculty adopting the text
Author: Pier Alberto Testoni
Publisher: Springer
ISBN: 9783030569921
Category : Medical
Languages : en
Pages : 1928
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Book Description
This unique book is the first to focus on diagnostic and therapeutic endoscopy in gastrointestinal and pancreatico-biliary diseases. It provides an in-depth overview of the state of the art in diagnostic and therapeutic endoscopy of both the digestive tract and the pancreatico-biliary ductal system, and documents the latest innovations in the field. The first part of the book addresses advanced diagnostic and therapeutic endoscopy of the digestive tract, discussing bariatric endoscopic surgery, and the treatment of neoplasia and precancerous lesions of the upper and lower GI tract, motor disorders, GERD, strictures, fistulae and bleeding. The second part of the book is explores ERCP and EUS procedures, covering the diagnosis and therapy of biliary ductal system and pancreatic diseases. Each chapter includes an abundance of color images that document in detail the devices, operative techniques and outcomes. Written by leading internationally renowned experts, the book is a valuable resource for both specialists and residents in gastroenterology and surgery.
Author: Joel E. Richter
Publisher: John Wiley & Sons
ISBN: 1119599601
Category : Medical
Languages : en
Pages : 73
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Book Description
THE ESOPHAGUS The Esophagus investigates the anatomy, physiology, and pathology of the esophagus. This sixth edition, revised and updated throughout, also explores the diagnosis and treatment of various esophageal conditions. It includes treatment guidelines approved by the two largest gastroenterology societies, the ACG and AGA, as befits a work co-edited by two former presidents of those organizations. Advancements in diagnostics are presented, as are developments in the surgical and drug therapies. Presented in full colour, and boasting an unrivalled team of editors and contributing authors, The Esophagus Sixth Edition will find a home wherever the anatomy, physiology, and pathology of the esophagus are studied and taught. This book is accompanied by a website containing all the figures from the book in PowerPoint format. www.wiley.com/go/richter/esophagus6e Praise for the Fifth Edition: “There is absolutely no doubt that this edition of the textbook will maintain its status as the go-to reference for esophageal conditions, and will remain a highly utilized and clinically useful resource for novice and experienced physicians and surgeons alike.” (Gastroenterology, 1 July 2013)
Author: Freeman Miller
Publisher: JHU Press
ISBN: 0801883547
Category : Health & Fitness
Languages : en
Pages : 537
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Book Description
When a child has a health problem, parents want answers. But when a child has cerebral palsy, the answers don't come quickly. A diagnosis of this complex group of chronic conditions affecting movement and coordination is difficult to make and is typically delayed until the child is eighteen months old. Although the condition may be mild or severe, even general predictions about long-term prognosis seldom come before the child's second birthday. Written by a team of experts associated with the Cerebral Palsy Program at the Alfred I. duPont Hospital for Children, this authoritative resource provides parents and families with vital information that can help them cope with uncertainty. Thoroughly updated and revised to incorporate the latest medical advances, the second edition is a comprehensive guide to cerebral palsy. The book is organized into three parts. In the first, the authors describe specific patterns of involvement (hemiplegia, diplegia, quadriplegia), explain the medical and psychosocial implications of these conditions, and tell parents how to be effective advocates for their child. In the second part, the authors provide a wealth of practical advice about caregiving from nutrition to mobility. Part three features an extensive alphabetically arranged encyclopedia that defines and describes medical terms and diagnoses, medical and surgical procedures, and orthopedic and other assistive devices. Also included are lists of resources and recommended reading.
