胃食管反流病(GERD)治疗.ppt

~30% 不复发 尝试停药 经验治疗 成功 症状符合GERD 每日一次PPI 失败 每日二次PPI 失败,诊断？ 尝试停药 经验治疗 成功 复发 ~30% 不复发 –按需?– 每日减半? 无需內镜 –PPI 每日一次4–8 周 症状符合GERD “阶梯向下”维持治疗 尝试停药 经验治疗 成功 复发 无复发 ~30% 不复发 复发 – ? 內镜 “阶梯向下”维持治疗 必须全量 PPI 治疗 抗反流手术 症状符合GERD 无需內镜 –PPI 每日一次4–8 周 谢谢 * * * * 胃酸过多可导致上述诸多疾病及症状的出现，因此抑酸是治疗酸相关性疾病的关键。胃内pH4持续时间与反流性食管炎愈合率的研究结果表明，胃内pH值维持在4以上的时间与8周后患者的治愈率呈线性相关，时间越长，治愈率越高，可见维持胃内pH值＞4是改善症状和提高愈合率最重要的一个环节。 * * 由于RE是一个长期, 复发性疾病, 因此需要长期维持治疗. 在此方面, 研究显示Nexium20毫克比较兰索拉唑15毫克更有效维持症状的长期缓解. * * Proportion of patients free from heartburn, regurgitation and epigastric pain after 6 months of on-demand therapy with esomeprazole 40 mg, esomeprazole 20 mg or placebo * Healing at 4 weeks with Nexium was greater than with pantoprazole across all grades of esophagitis, and significantly higher for grades B-D. The efficacy of pantoprazole declined to a greater extent with increasing severity of disease, such that in patients with grade C esophagitis, the healing rate with pantoprazole was 60.1%, compared with 71.1% for Nexium. The benefit was even more marked in patients with grade D esophagitis, where the healing rate was down to 40.2% with pantoprazole but was still 61.4% with Nexium. These observations mirror similar results versus omeprazole and lansoprazole, with greater consistency of healing seen across all grades of esophagitis with Nexium. These findings demonstrate that Nexium is the PPI with the greatest healing rates in virtually all reflux esophagitis patients. The results are of particular relevance for the primary care physician, who often treats patients without endoscopy, i.e. without knowledge of the severity of the underlying disease. Graph included in UEGW 2003 poster Rates included in CDDW 2004 abstract * * * TLESR是指非吞咽时LES发生了自发松弛。此时常伴有酸反流。 Transient lower esophageal sphincter relaxation is the major mechanism of reflux. This is an example of a transient lower oesophageal sphincter relaxation. It is characterised by a prolonged lower esophageal sphincter relaxation, not tr