FIP-WGO Joint Session

The session was organized by the International Pharmaceutical Federation (FIP) at the World Congress of Pharmacy and Pharmaceutical Sciences, held August 30—September 4, 2014 in Bangkok, Thailand. It represented a unique opportunity for World Gastroenterology Organisation (WGO), representing gastroenterologists throughout the world, to engage directly with pharmacists on the approach to the management of common gastrointestinal (GI) symptoms. The WGO Global Guideline on common GI symptoms in the community (http://www.worldgastroenterology.org/Common-Symptoms) was presented by the President of the Gastroenterological Association of Thailand, Professor Varocha Mahachai from Chulalongkorn University and Bangkok Medical Center on behalf of WGO. The WGO Global Guideline on the management of common GI symptoms, including heartburn, abdominal pain/discomfort, bloating, and constipation, was developed in 2013 by a joint committee consisting of GI experts, primary care physicians, and representatives of FIP. The main objective was to provide a unique and globally useful guideline that can help in the management in common GI symptoms in the community. The guideline is unique in featuring 4 levels of care in a cascade approach, starting from self-care, and then the pharmacists’ role, before moving on to the roles of primary care doctors and, finally, specialists. The majority of patients in the community present with symptoms rather than diagnosed conditions. The WGO Global Guidelines have been developed to provide resource-sensitive recommendations, rather than focusing on the gold standard of diagnosis and treatment. Most patients are troubled, but not disabled, by these GI symptoms and they tend to seek relief using self-care, over-the-counter (OTC) medications. Functional GI disorders are common and comprise a large proportion of GI practice. When symptoms are mild patients tend to self-medicate, but they should consult a physician if they fail to improve. The approach to other common GI symptoms, including abdominal pain, bloating, and constipation, was further discussed. It is important to recognize those alarm features that should prompt consultation with a physician. This was followed by a presentation by Eugene Lutz (USA), a member of the executive committee of the FIP community pharmacy section (CPS), who further discussed the “impact of guidelines in pharmacy practice,” emphasizing the role of community pharmacists in the treatment of common GI symptoms. The application of daily pharmacy practice was presented by Paul Sinclair (CPS, Australia) using a couple of case studies. Self-care in the 21st Century: Reflux and Heartburn as a Self-care Model. Speakers (from left to right): Varocha Mahachai, MD, Gerald Dziekan, MD, John Chave, MA, John Alfred Bell, MA, Charles Pollack, MD, PhD.Self-care in the 21st Century: Reflux and Heartburn as a Self-care Model. Speakers (from left to right): Varocha Mahachai, MD, Gerald Dziekan, MD, John Chave, MA, John Alfred Bell, MA, Charles Pollack, MD, PhD. Reflux and heartburn as a self-care model was another topic of discussion as a part of an industry-sponsored satellite symposium on self-care in the 21st century. Different issues of self-care were discussed by experts in the field, including the role of pharmacists, a health care economic perspective, with reflux/heartburn used as a self-care model. In dealing with heartburn, which is the hallmark of gastroesophageal reflux disease, it is important to recognize the alarm symptoms, which should prompt further investigations. Treatment includes lifestyle modification and acid reducing agents. The use of prokinetic agents has been limited by their unproven efficacy and side effects. As far as self-care is concerned in heartburn/gastroesophageal reflux disease, the relief of symptoms is the main goal. In the presence of alarm features, self-treatment should be avoided and patients should be referred to GI specialists for further investigation. There is an increasing public interest in self-medication for common GI symptoms with OTC medications that have become readily available. The WGO Global Guideline was developed with a joint effort among GI specialists, primary care experts, and FIP representatives to guide in the management of common GI symptoms, including: heartburn, abdominal pain/discomfort, bloating, and constipation. The guideline provides diagnostic and treatment cascades, with resource-sensitive recommendations mainly focusing on self-care to the role of pharmacists in the utilization of the OTC medications. Pharmacists could serve as frontline health care professionals in self-care, recognizing problems and providing consultations related to therapy (such as drug side effects, drug interactions, and timely referrals to primary care providers or GI specialists). The main concerns of the self-care approach using OTC medications are the possibilities of misdiagnosis or undertreatment of the underlying conditions, although it is unlikely as they are of mild severity. It is important to identify patients with a high likelihood of a serious condition in the presence of alarm features and failed therapy so that they can be referred for proper investigation and management. FigureWORLD DIGESTIVE HEALTH DAY 2015 WDHD 2015—Heartburn: A Global Perspective Each year on May 29 the World Gastroenterology Organisation celebrates World Digestive Health Day (WDHD) to raise awareness about a particular digestive or liver disease. The 2015 WDHD theme is “Heartburn: A Global Perspective.” Led by Chairman, Professor David Armstrong (Canada), the WGO Foundation Chair and Vice Chair, Eamonn Quigley (USA) and Richard Hunt (UK), and the 2015 Steering Committee, Mary Afihene (Ghana), Serhat Bor (Turkey), Henry Cohen (Uruguay), Colin Howden (USA,) Peter Katelaris (Australia), Varocha Mahachai (Thailand), Govind Makharia (India), Joaquim Prado P de Moraes-Filho (Brazil), Ala Sharara (Lebanon), Vincenzo Stanghellini (Italy), and Frank Zerbib (France), the WGO wishes to raise awareness of heartburn and to provide a broad overview on this common symptom by providing gastroenterologists and, hence their patients and the lay public, with an understanding of the latest basic and clinical research in the pathogenesis, investigation, and treatment of esophageal symptoms. “Heartburn: A Global Perspective,” seeks to translate research into clinical practice and facilitate communication between health care providers, health care payers, and heartburn sufferers to ensure that patients receive appropriate dietary and lifestyle advice as well as appropriate investigations and treatment, relevant to their condition and circumstances. World Digestive Health Day 2015 takes place next month and will bring together people from around the world, in collaboration with over 100 of WGO Member Societies and regional affiliates through the development of educational and training materials, including a publication of the WGO Cascades Guidelines on the Management of Gastroesophageal Reflux Disease. Have you started planning your event? While the official date of WDHD is May 29th, many events take place both before and after. Past events include public campaigns, courses, and lectures on treatments of the current theme, marathons, walkathons, national meetings, press conferences, television and radio interviews, creating a country’s own WDHD Day, publications, and much more. For questions regarding WDHD or to officially submit your event for placement on the calendar, please email [email protected]. You may find a variety of tools and resources, which benefit your physicians, other health care professionals, patients, and the general public, by visiting http://www.wgofoundation.org/wdhd-2015.html. Please also visit the WDHD 2015 web site to request a copy of the 2015 WDHD logo for your use in promoting this year’s WDHD campaign. Watch for the WGO monthly e-Alert, which will provide the latest news and updates, as well as issues of the quarterly e-WGN (http://www.worldgastroenterology.org/wgn.html), which features summaries of events that are taking place throughout 2015. We look forward to a productive and successful campaign in providing a global perspective on the management of heartburn! Figure

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