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Behavioral Therapy for Functional Heartburn: Recommendation Statements
Clinical Gastroenterology and Hepatology ( IF 12.6 ) Pub Date : 2024-03-20 , DOI: 10.1016/j.cgh.2024.03.004
Livia Guadagnoli , Rena Yadlapati , John Pandolfino , Alyse Bedell , Anjali U. Pandit , Kerry B. Dunbar , Ronnie Fass , Richard Gevirtz , C. Prakash Gyawali , Stephen E. Lupe , Megan Petrik , Megan E. Riehl , Jessica Salwen-Deremer , Madison Simons , Kathryn N. Tomasino , Tiffany Taft

Brain-gut behavior therapies (BGBT) are increasingly recognized as effective therapeutic interventions for functional heartburn. However, recommendations regarding candidacy for treatment, initial treatment selection, and navigating treatment non-response have not been established for functional heartburn specifically. The aim of this study was to establish expert-based recommendations for behavioral treatment in patients with functional heartburn. The validated RAND/University of California, Los Angeles Appropriateness Method was applied to develop recommendations. A 15-member panel composed of 10 gastrointestinal psychologists and 5 esophageal specialists ranked the appropriateness of a series of statements on a 9-point interval scale over 2 ranking periods. Statements were within the following domains: pre-therapy evaluation, candidacy criteria for BGBT, selection of initial BGBT, role of additional therapy for initial non-response to BGBT, and role of pharmacologic neuromodulation. The primary outcome was appropriateness of each intervention based on the recommendation statements. Recommendations for psychosocial assessment (eg, hypervigilance, symptom-specific anxiety, health-related quality of life), candidacy criteria (eg, motivated for BGBT, acknowledges the role of stress in symptoms), and treatment were established. Gut-directed hypnotherapy or cognitive behavioral therapy were considered appropriate BGBT for functional heartburn. Neuromodulation and/or additional BGBT were considered appropriate in the context of non-response. Gut-directed hypnotherapy and/or cognitive behavioral therapy are recommended as appropriate behavioral interventions for heartburn symptoms, depending on clinical indication, specific gut-brain targets, and preferred treatment modality (pharmacologic vs non-pharmacologic). Pre-therapy evaluation of psychosocial processes and candidacy for BGBT are important to determine eligibility for referral to psychogastroenterology services.

中文翻译:

功能性胃灼热的行为疗法:建议声明

脑肠行为疗法(BGBT)越来越被认为是功能性胃灼热的有效治疗干预措施。然而,关于治疗候选、初始治疗选择和治疗无反应的建议尚未专门针对功能性胃灼热建立。本研究的目的是为功能性胃灼热患者的行为治疗建立基于专家的建议。采用经验证的兰德/加州大学洛杉矶分校适当性方法来制定建议。由 10 名胃肠心理学家和 5 名食管专家组成的 15 名小组在 2 个排名周期内按照 9 分区间量表对一系列陈述的适当性进行了排名。声明涉及以下领域:治疗前评估、BGBT 候选标准、初始 BGBT 的选择、额外治疗对 BGBT 初始无反应的作用以及药物神经调节的作用。主要结果是基于建议声明的每项干预措施的适当性。建立了心理社会评估(例如,过度警觉、症状特异性焦虑、​​健康相关生活质量)、候选标准(例如,BGBT 动机、承认压力在症状中的作用)和治疗的建议。肠道导向催眠疗法或认知行为疗法被认为是治疗功能性胃灼热的适当 BGBT。在无反应的情况下,神经调节和/或额外的 BGBT 被认为是适当的。建议将肠道导向催眠疗法和/或认知行为疗法作为胃灼热症状的适当行为干预措施,具体取决于临床适应症、特定的肠脑目标和首选治疗方式(药物与非药物)。心理社会过程的治疗前评估和 BGBT 的候选资格对于确定转诊至心理胃肠病学服务的资格非常重要。
更新日期:2024-03-20
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