A patient with heartburn practicing self-treatment, on an outpatient visit

Abstract

More than 40% of adult Russians periodically feel heartburn. Progression of the disease leads to a number of complications shortening patients’ life. However, patients try to cope with problems by themselves, without receiving adequate early treatment. Only when the life quality worsens, which evidences progression of the disease, they turn to a doctor. Success of treatment depends on the level of the patient’s compliance, life-long complete and regular adherence to treatment recommended by the doctor. With this, an outpatient with a chronic disease should provide the most part of the required medical service by himself. However, patients often change the therapeutic measures on their own impairing the result of treatment.

The given below clinical case of patient Zh., 38 years old, with heartburn and existing risk factors of other non-infectious diseases is a typical illustration of the interaction of a general practitioner and an outpatient practicing self-treatment. Facing the situation of necessary regular medical monitoring and life-long complex intervention, the patient uses only easy-to-follow doctor’s recommendations and understandable for him treatment methods.

Conclusion. On an example of this clinical case, a possible necessary and sufficient plan o f informing outpatient is presented containing information of the tactics of his behavior for full realization of medical recommendations. For successful adaptation of an outpatient with chronic health problems and harmonic attitude to the disease, the doctor should be maximally specific about necessary and adequate measures for correction of the patient’s behavior for the fullest realization of therapeutic recommendations. Recommendations should contain understandable information of basic medicinal and non-medicinal therapy in remission (the essential vital stereotypes – work-rest regime, type and regime of nutrition, physical activity and principles of monitoring the condition), of signs of exacerbation and methods of therapy «on demand» and also information of symptoms requiring urgent assistance, of risks of self-treatment, of visiting the doctor in case new or vivid symptoms appear, of the dates of planned examinations by the doctor. These recommendations are not applicable to patients with severe and manifest course of the disease, with disharmonic attitude to the disease, and in case of inadequate organization capacities and low compliance of the patient.

Keywords

heartburn / an outpatient / compliance / self-treatment

References

[1] Drozdov VN, Serebrova SYu, Rykova SM, et al.; Shikh EV, editor. Gastroezofageal’naya reflyuksnaya bolezn’: klinicheskiye proyavleniya, medikamentoznaya terapiya. Moscow: GEOTAR-Media; 2019 (In Russ).

[2] Дроздов В.Н., Сереброва С.Ю., Рыкова С.М., и др.; Ших Е.В., ред. Гастроэзофагеальная рефлюксная болезнь: клинические проявления, медикаментозная терапия. М.: ГЕОТАР-Медиа; 2019.

[3] Lazebnik LB, Masharova AA, Bordin DS, et al. Results of a multicenter trial «Epidemiology of gastroesophageal reflux disease in Russia» (MEGRE). Terapevticheskii Arkhiv. 2011;83(1):45-50. (In Russ).

[4] Лазебник Л.В., Машарова А.А., Бордин Д.С., и др. Результаты мультицентрового исследования «Эпидемиология гастроэзофагеальной рефлюксной болезни в России» (МЭГРЕ) // Терапевтический архив. 2011. Т. 83, №1. С. 45-50.

[5] Hunt R, Armstrong D, Katelaris P, et al.; World Gastroenterology Organisation Global Guidelines: GERD Global Perspective on Gastroesophageal Reflux Disease. Journal of Clinical Gastroenterology. 2017; 51(6):467-78. doi:10.1097/MCG.0000000000000854

[6] Hunt R., Armstrong D., Katelaris P., et al. World Gastroenterology Organisation Global Guidelines: GERD Global Perspective on Gastroesophageal Reflux Disease // Journal of Clinical Gastroenterology. 2017. Vol. 51, №6. P. 467-478. doi:10.1097/MCG.0000000000000854

[7] Kaybysheva VO, Kucheryavy YuA, Trukhmanov AS, et al. Results of multicenter observation study on application of international questionnaire GerdQ for diagnostics of gastroesophageal reflux disease. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2013;(5):15-23. (In Russ).

[8] Кайбышева В.О., Кучерявый Ю.А., Трухманов А.С., и др. Результаты многоцентрового наблюдательного исследования по применению международного опросника GerdQ для диагностики гастроэзофагеальной рефлюксной болезни // Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2013. №5. С. 15-23.

[9] de Bortoli N, Guidi G, Martinucci I, et al. Voluntary and controlled weight loss can reduce symptoms and proton pump inhibitor use and dosage in patients with gastroesophageal reflux disease: a comparative study. Diseases of the Esophagus. 2016;29(2):197-204. doi:10.1111/dote.12319

[10] de Bortoli N., Guidi G., Martinucci I., et al. Voluntary and controlled weight loss can reduce symptoms and proton pump inhibitor use and dosage in patients with gastroesophageal reflux disease: a comparative study // Diseases of the Esophagus. 2016. Vol. 29, №2. P. 197-204. doi:10.1111/dote.12319

[11] Goh KL. Changing epidemiology of gastroesophageal reflux disease in the Asian-Pacific region: an overview. Journal of Gastroenterology and Hepatology. 2004;19(3):S22-5. doi:10.1111/j.1440-1746.2004.03591.x

[12] Goh K.L. Changing epidemiology of gastroesophageal reflux disease in the Asian-Pacific region: an overview // Journal of Gastroenterology and Hepatology. 2004. Vol. 19, №3. P. S22-S25. doi:10.1111/j.1440-1746.2004.03591.x

[13] Lagergren J, Bergström R, Nyrén O. Association between body mass and adenocarcinoma of the esophagus and gastric cardia. Annals of Internal Medicine. 1999;130(11):883-90. doi:10.7326/003-4819-130-11-199906010-00003

[14] Lagergren J., Bergström R., Nyrén O. Association between body mass and adenocarcinoma of the esophagus and gastric cardia // Annals of Internal Medicine. 1999. Vol. 130, №11. P. 883-890. doi:10.7326/003-4819-130-11-199906010-00003

[15] Person E, Rife C, Freeman J, et al. A novel sleep positioning device reduces gastroesophageal reflux: a randomized controlled trial. Journal of Clinical Gastroenterology. 2015;49(8):655-9. doi:10.1097/ MCG.0000000000000359

[16] Person E., Rife C., Freeman J., et al. A novel sleep positioning device reduces gastroesophageal reflux: a randomized controlled trial // Journal of Clinical Gastroenterology. 2015. Vol. 49, №8. P. 655-659. doi:10.1097/MCG.0000000000000359

[17] PRAC recommends restricting use of domperidone. Available at: https://www.ema.europa.eu/en/documents/press-release/prac-recommends-restricting-use-domperidone_en.pdf. Accessed: 2020 May 5.

[18] PRAC recommends restricting use of domperidone. Доступно по: https://www.ema.europa.eu/en/docu-ments/press-release/prac-recommends-restricting-use-domperidone_en.pdf. Ссылка активна на 5 мая 2020.

[19] European Medicines Agency recommends changes to the use of metoclopramide. Available at: https:// www.ema.europa.eu/en/documents/press-release/european-medicines-agency-recommends-changes-use-metoclopramide_en.pdf. Accessed: 2020 May 5.

[20] European Medicines Agency recommends changes to the use of metoclopramide. Доступно по: https://www.ema.europa.eu/en/documents/press-release/european-medicines-agency-recommends-changes-use-metoclopramide_en.pdf. Ссылка активна на 5 мая 2020.

[21] Movshovich BL. Ambulatornaya meditsina: prakticheskoye rukovodstvo dlya vrachey pervichnogo zvena zdravookhraneniya. Moscow: MIA; 2010. (In Russ).

[22] Мовшович Б.Л. Амбулаторная медицина: практическое руководство для врачей первичного звена здравоохранения. М.: МИА; 2010.

[23] Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. The American Journal of Gastroenterology. 2013;108(3):308-29. doi:10.1038/ajg.2012.444

[24] Katz P.O., Gerson L.B., Vela M.F. Guidelines for the diagnosis and management of gastroesophageal reflux disease // The American Journal of Gastroenterology. 2013. Vol. 108, №3. P. 308-329. doi:10.1038/ajg.2012.444

[25] Flameling RD, Numans ME, ter Linde J, et al. Different characteristics of patients with gastrooesophageal reflux disease on their path through health-care: a population follow-up study. European Journal of Gastroenterology & Hepatology. 2010;22(5): 578-82. doi:10.1097/MEG.0b013e328335638c

[26] Flameling R.D., Numans M.E., ter Linde J., et al. Different characteristics of patients with gastrooesophageal reflux disease on their path through healthcare: a population followup study // European Journal of Gastroenterology & Hepatology. 2010. Vol. 22, №5. P. 578-582. doi:10.1097/MEG.0b013e328335638c

[27] Kvarnström K, Airaksinen M, Liira H. Barriers and facilitators to medication adherence: a qualitative study with general practitioners. BMJ Open. 2018; 8(1):e015332. doi:10.1136/bmjopen-2016-015332

[28] Kvarnström K., Airaksinen M., Liira H. Barriers and facilitators to medication adherence: a qualitative study with general practitioners // BMJ Open. 2018. Vol. 8, №1. P. e015332. doi:10.1136/bmjopen-2016-015332

[29] Webber D, Guo Z, Mann S. Self-Care in health: we can define it, but should we also measure it? Self Care. 2013;4(5):101-6.

[30] Webber D., Guo Z., Mann S. Selfcare in health: we can define it, but should we also measure it? // Self Care. 2013. Vol. 4, №5. Р. 101-106.

[31] Kickbusch I. A Game Change in Global Health: The Best Is Yet to Come. Public Health Reviews. 2014;35(1). doi:10.1007/BF03391687

[32] Kickbusch I. A Game Change in Global Health: The Best Is Yet to Come // Public Health Reviews. 2014. Vol. 35, №1. doi:10.1007/BF03391687

[33] Durand H, Casey M, Glynn LG, et al. A qualitative comparison of high and low adherers with apparent treatment-resistant hypertension. Psychology, Health & Medicine. 2020;25(1):64-77. doi:10.1080/13548 506.2019.1619788

[34] Durand H., Casey M., Glynn L.G., et al. A qualitative comparison of high and low adherers with apparent treatmentresistant hypertension // Psychology, Health & Medicine. 2020. Vol. 25, №1. P. 64-77. doi:10.1080/13548506.2019.1619788

[35] Ferroni E, Casotto V, Pigato M, et al. Patient and General Practitioner characteristics influencing the management of non-insulin-treated diabetes mellitus: A cross-sectional study in Italy. Diabetes Research and Clinical Practice. 2016;116:192-201. doi:10.1016/j.diabres.2016.04.038

[36] Ferroni E., Casotto V., Pigato M., et al. Patient and General Practitioner characteristics influencing the management of non-insulin-treated diabetes mellitus: A crosssectional study in Italy // Diabetes Research and Clinical Practice. 2016. Vol. 116. P. 192-201. doi:10.1016/j.diabres.2016.04.038

[37] Krylova IA. Sovershenstvovaniye profilakticheskoy pomoshchi ambulatornym patsiyentam na osnove rezul’tatov psikhologicheskogo issledovaniya. Cardio-vascular Therapy and Prevention. 2017;16(suppl 3):165-6. (In Russ).

[38] Крылова И.А. Совершенствование профилактической помощи амбулаторным пациентам на основе результатов психологического исследования // Кардиоваскулярная терапия и профилактика. 2017. Т. 16, Прил. 3. С. 165-166.

[39] Znyk M, Polańska K, Wojtysiak P, et al. Predictors o Counselling Related to Healthy Lifestyle Carried Out By a General Practitioner. International Journal of Environmental Research and Public Health. 2019;16(22):4475. doi:10.3390/ijerph16224475

[40] Znyk M., Polańska K., Wojtysiak P., et al. Predictors o Counselling Related to Healthy Lifestyle Carried Out By a General Practitioner // International Journal of Environmental Research and Public Health. 2019. Vol. 16, №22. P. 4475. doi:10.3390/ijerph16224475

[41] Sheikh I, Waghray A, Waghray N, et al. Consumer use of over-the-counter proton pump inhibitors in patients with gastroesophageal reflux disease. The American Journal of Gastroenterology. 2014; 109 (6):789-94. doi:10.1038/ajg.2013.421

[42] Sheikh I., Waghray A., Waghray N., et al. Consumer use of over-the-counter proton pump inhibitors in patients with gastroesophageal reflux disease // The American Journal of Gastroenterology. 2014. Vol. 109, №6. P. 789-794. doi:10.1038/ajg.2013.421

[43] Hayden CW, Bernstein CN, Hall RA, et al. Usage of Supplemental Alternative Medicine by Community-Based Patients with Gastroesophageal Reflux Disease (GERD). Digestive Diseases and Sciences. 2002;47(1):1-8. doi:10.1023/a:1013264730992

[44] Hayden C.W., Bernstein C.N., Hall R.A., et al. Usage of Supplemental Alternative Medicine by Community-Based Patients with Gastroesophageal Reflux Disease (GERD) // Digestive Diseases and Sciences. 2002. Vol. 47, №1. P. 1-8. doi:10.1023/a:1013264730992

[45] Luriya RA. Vnutrennyaya kartina bolezni i iatrogennyye zabolevaniya. Moscow: Meditsina; 1977. (In Russ).

[46] Лурия Р.А. Внутренняя картина болезни и иатрогенные заболевания. М.: Медицина; 1977.

[47] Tadjiev IYa, Belostotsky AV, Kamynina IN. The development of general practitioner practice in the Russian Federation. Problems of Social Hygiene, Public Health and History of Medicine. 2018;26 (1):20-5. (In Russ). doi:10.1016/0869-866X-2018-26-1-20-25

[48] Таджиев И.Ю., Белостоцкий А.В., Камынина И.Н. Развитие общей врачебной практики в Российской Федерации // Проблемы социальной гигиены, здравоохранения и истории медицины. 2018. Т. 26, №1. С. 20-25. doi:10.1016/0869-866X-2018-26-1-20-25

[49] Poynard T. [Role and limits of self-medication in the therapeutic strategy of gastroesophageal reflux in adults]. Gastroenterologie Clinique et Biologique. 1999;23(1 Pt 2):S176-9.

[50] Poynard T. [Role and limits of selfmedication in the therapeutic strategy of gastroesophageal reflux in adults] // Gastroenterologie Clinique et Biologique. 1999. Vol. 23, №1. Part 2. P. S176-S179.

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