Management of Patients With Refractory Reflux-Like Symptoms Despite Proton Pump Inhibitor Therapy: Evidence-Based Consensus Statements.

Background: Many patients diagnosed with gastro-oesophageal reflux disease (GERD) have persistent symptoms despite proton pump inhibitor (PPI) therapy.

Aims: The aim of this consensus is to provide evidence-based statements to guide clinicians caring for patients with refractory reflux-like symptoms (rRLS) or refractory GERD.

Methods: This consensus was developed by the International Working Group for the Classification of Oesophagitis.

Perceptions and Practices of Primary Care Providers in Europe and the US in the Diagnosis and Treatment of Irritable Bowel Syndrome: A Multinational Survey.

Background: The knowledge and proficiency of primary care practitioners (PCPs) in diagnosing and managing irritable bowel syndrome (IBS) remain generally low and variable internationally. This variability is partly due to a lack of familiarity with the Rome Foundation diagnostic criteria and treatment guidelines for this condition.

Methods: We conducted an electronic survey of PCPs in the United States and nine European countries to assess their understanding of IBS pathophysiology; the use of Rome IV criteria in diagnosis, knowledge of and frequency in prescribing various recommended treatments; and the likelihood of referring patients with suspected IBS to subspecialists.

Proton Pump Inhibitors: Rational Use and Use-Reduction - The Windsor Workshop.

Background: Despite deprescribing initiatives to curb overutilization of proton pump inhibitors (PPIs), achieving meaningful reductions in PPI use is proving a challenge.

Summary: An international group of primary care doctors and gastroenterologists examined the literature surrounding PPI use and use-reduction to clarify: (i) what constitutes rational PPI prescribing; (ii) when and in whom PPI use-reduction should be attempted; and (iii) what strategies to use when attempting PPI use-reduction.

Key Messages: Before starting a PPI for reflux-like symptoms, patients should be educated on potential causes and alternative approaches including dietary and lifestyle modification, weight loss, and relaxation strategies.

ACCORD (ACcurate COnsensus Reporting Document): A reporting guideline for consensus methods in biomedicine developed via a modified Delphi.

Background: In biomedical research, it is often desirable to seek consensus among individuals who have differing perspectives and experience. This is important when evidence is emerging, inconsistent, limited, or absent. Even when research evidence is abundant, clinical recommendations, policy decisions, and priority-setting may still require agreement from multiple, sometimes ideologically opposed parties.

Management advice for patients with reflux-like symptoms: an evidence-based consensus.

Patients with reflux-like symptoms (heartburn and regurgitation) are often not well advised on implementing individualised strategies to help control their symptoms using dietary changes, lifestyle modifications, behavioural changes or fast-acting rescue therapies. One reason for this may be the lack of emphasis in management guidelines owing to 'low-quality' evidence and a paucity of interventional studies. Thus, a panel of 11 gastroenterologists and primary care doctors used the Delphi method to develop consolidated advice for patients based on expert consensus.

Colorectal cancer and advanced adenoma incidence during post-polypectomy surveillance: a national cohort study in the English Bowel Cancer Screening Programme.

Background: Improved colonoscopy quality has led to debate about whether all post-polypectomy surveillance is justified. We evaluated surveillance within the English Bowel Cancer Screening Programme (BCSP) to determine the yield of surveillance and identify predictive factors for surveillance outcome.

Methods: We performed a retrospective cohort study of individuals undergoing post-polypectomy surveillance between July 2006 and January 2017.

The forgotten dimension of integrated care: barriers to implementing integrated clinical care in English NHS hospitals.

Multimorbid patients who enter English NHS hospitals are frequently subject to care pathways designed to assess, diagnose and treat single medical conditions. Opportunities are thereby lost to offer patients more holistic, person-centred care. Hospital organisations elsewhere are known to use in-hospital, multi-specialty, integrated clinical care (ICC) to overcome this problem.

ACCORD guideline for reporting consensus-based methods in biomedical research and clinical practice: a study protocol.

Background: Structured, systematic methods to formulate consensus recommendations, such as the Delphi process or nominal group technique, among others, provide the opportunity to harness the knowledge of experts to support clinical decision making in areas of uncertainty. They are widely used in biomedical research, in particular where disease characteristics or resource limitations mean that high-quality evidence generation is difficult. However, poor reporting of methods used to reach a consensus - for example, not clearly explaining the definition of consensus, or not stating how consensus group panellists were selected - can potentially undermine confidence in this type of research and hinder reproducibility.

Knowledge gaps in the management of refractory reflux-like symptoms: Healthcare provider survey.

Background: Refractory reflux-like symptoms have a substantial impact on patients and healthcare providers. The aim of the survey was to qualitatively assess the needs and attitudes of practicing clinicians around the management of refractory reflux symptoms and refractory gastroesophageal reflux disease (rGERD).

Methods: An International Working Group for the Classification of Oesophagitis (IWGCO) steering committee invited clinicians to complete an online survey including 17 questions.

Review article: rethinking the "ladder" approach to reflux-like symptom management in the era of PPI "resistance" - a multidisciplinary perspective.

Background: Despite widespread adoption of potent acid suppression treatment with proton pump inhibitors (PPI) for reflux-like symptoms, persistent symptoms are commonly reported in primary care and community studies.

Aims: This multidisciplinary review critically evaluates how the management of reflux-like symptoms could better reflect their multifactorial pathophysiology.

Methods: A panel of experts (from general practice, gastroenterology and gastropsychology) attended a series of workshops to review current management and propose a framework for the provision of more individualised care.

Chronic Constipation in Adults: The Primary Care Approach.

Background: Primary care is normally the initial point of presentation and management of patients with chronic constipation (CC). CC has a prevalence of 3-27%, predominantly amongst females and in the older population, and is associated with a reduced quality of life. Effective management can be a challenge without a structured approach.

Undiagnosed microscopic colitis: a hidden cause of chronic diarrhoea and a frequently missed treatment opportunity.

Microscopic colitis (MC) is a treatable cause of chronic, non-bloody, watery diarrhoea, but physicians (particularly in primary care) are less familiar with MC than with other causes of chronic diarrhoea. The colon in patients with MC is usually macroscopically normal. MC can only be diagnosed by histological examination of colonic biopsies (subepithelial collagen band >10 µm (collagenous colitis) or >20 intraepithelial lymphocytes per 100 epithelial cells (lymphocytic colitis), both with lamina propria inflammation).

European society of neurogastroenterology and motility guidelines on functional constipation in adults.

Introduction: Chronic constipation is a common disorder with a reported prevalence ranging from 3% to 27% in the general population. Several management strategies, including diagnostic tests, empiric treatments, and specific treatments, have been developed. Our aim was to develop European guidelines for the clinical management of constipation.

Revisiting Montreal: New Insights into Symptoms and Their Causes, and Implications for the Future of GERD.

The Montreal definition of gastroesophageal reflux disease (GERD) provided a rationale for acid suppression medication without investigation, thus enhancing the management of the substantial symptom burden in these patients. Increased proton-pump inhibitor use has also highlighted their limitations, with one third of "typical" symptoms known to be refractory. Most refractory symptoms are ascribed to reflux hypersensitivity (RH) and functional heartburn (FH).

The persistent problem of integrated care in English NHS hospitals.

Purpose The purpose of this paper is to determine whether some aspects of the distinctive Mayo Clinic care model could be translated into English National Health Service (NHS) hospital settings, to overcome the fragmented and episodic nature of non-emergency patient care. Design/methodology/approach The authors used a rapid review to assess the literature on integrated clinical care in hospital settings and critical analysis of links between Mayo Clinic's care model and the organisation's performance and associated patient outcomes. Findings The literature directly concerned with Mayo Clinic's distinctive ethos and approach to patient care is limited in scope and largely confined to "grey" sources or to authors and institutions with links to Mayo Clinic.

Vaping Smoking: A Quest for Efficacy and Safety of E-cigarette.

Background: Electronic Cigarettes (ECIGs) are devices with a heating element which produces aerosol for inhalation. They have been propagated as a healthier alternative to tobacco smoking and a potential device for smoking cessation, despite non-documentation of their long-term adverse health effects.

Objectives: With the glorification of ECIG, its use has increased even among non-tobacco users.

Systematic review: probiotics in the management of lower gastrointestinal symptoms - an updated evidence-based international consensus.

Background: In 2013, a systematic review and Delphi consensus reported that specific probiotics can benefit adult patients with irritable bowel syndrome (IBS) and other gastrointestinal (GI) problems.

Aim: To update the consensus with new evidence.

Methods: A systematic review identified randomised, placebo-controlled trials published between January 2012 and June 2017.

Irritable bowel syndrome diagnosis and management: A simplified algorithm for clinical practice.

Background: Effective management of irritable bowel syndrome (IBS), a common functional gastrointestinal disorder, can be challenging for physicians because of the lack of simple diagnostic tests and the wide variety of treatment approaches available.

Objective: The objective of this article is to outline a simple algorithm for day-to-day clinical practice to help physicians navigate key stages to reaching a positive IBS diagnosis and guidance on how to prioritise the use of specific management strategies.

Methods: This algorithm was based on the opinion of an expert panel evaluating current evidence.

Should heart failure be regarded as a terminal illness requiring palliative care? A study of heart failure patients', carers' and clinicians' understanding of heart failure prognosis and its management.

Objectives: Communication and planning for heart failure (HF) care near the end of life is known to be complex. Little is known about how the patient experience of palliative assessment and communication needs change over time, and how this might inform management. Our aim was to explore experiences of giving or receiving a prognosis and advanced palliative care planning (ACP) for those with HF.

Ambiguities in the Guidelines for the Management of Arterial Hypertension: Indian Perspective with a Call for Global Harmonization.

Many medical professional societies have formulated guidelines to treat hypertension, but there existed differences with respect to diagnosis, blood pressure (BP) targets, pharmacotherapy of hypertension, and grades of evidence. A MEDLINE search for hypertension guidelines was performed to compare Indian guidelines for hypertension (IGH) with these guidelines. A majority of the guidelines had consensus on the cutoff value (140/90 mmHg, recorded twice) to diagnose hypertension.

Use of Rome criteria for the diagnosis of irritable bowel syndrome in primary care: a survey among European countries.

Background And Objectives: The majority of patients with irritable bowel syndrome (IBS) are diagnosed and treated in primary care. The aim of this study was to investigate the implementation of the Rome criteria in daily primary care clinical practice and adherence of general practitioners (GPs) to recommended diagnostic approaches for IBS.

Patients And Methods: A survey consisting of 18 questions was distributed across 11 European countries and was used to assess GPs' diagnostic approach of IBS, the use of Rome criteria in daily practice and GPs' perspective on the aetiology of the disorder.

Reliable exclusion of prognostically significant coronary disease in left ventricular dysfunction by cardiac MRI.

Aim: To assess the ability of cardiac magnetic resonance (CMR) to exclude prognostically significant coronary artery disease (CAD) in patients with left ventricular systolic dysfunction (LVSD).

Materials And Methods: A cohort of patients who underwent both X-ray angiography and CMR since 2006 was reviewed retrospectively. Records of those with European criteria for LVSD (left ventricular ejection fraction [LVEF] <50% or LV end-diastolic volume index [LVEDVI] ≥97 ml/m) on CMR or transthoracic echo were analysed.