GERD胃食管反流病__培训课件.pptVIP

电刺激治疗 躯体电刺激 电针刺激 经皮电刺激 LES电刺激 要 点 GERD的典型症状为烧心、反酸 分类：NERD EE BE 反流监测是诊断GERD的金标准 目前治疗以PPI 和促动力药物为主 Thank you Thank you 指存在反流相关的不适症状，但内镜下未见Barrett 食管及食管黏膜破损。 内镜下可见食管黏膜破损。1994年洛杉矶会议提出确 的分级标准，根据内镜下食管病变程度分为A—D级。 食管远段的鳞状上皮被柱状上皮取代。 * * Esophagus: Gastroesophageal reflux (GER) may cause heartburn that is common and occurs in 18% of the adult population in the United State [21]. The development of GER is a multifactorial process and main motor dysfunctions include: 1) Decreased lower esophageal sphincter (LES) pressure. There is a positive pressure gradient between the stomach and the esophagus that tends to promote the reflux from the stomach into the esophagus. LES normally can counteract this pressure gradient and effectively prevent reflux by maintenance of a basal resting pressure at gastroesophageal junction (GEJ) between 10-40 mmHg. Resting LES pressure represents a combination of the intrinsic sphincter which is a 3 cm apart of tonically contracting smooth muscle at the GEJ as well as the contribution by the left crus of diaphragm - sometimes referred to the external LES. Low resting LES pressure (10 mm Hg) usually leads to episodes of GER particularly at night during sleep when the benefits of upright posture and gravity are lost. This has been frequently observed in patients with severe GERD [22, 23]. The LES pressure is a significant predictor of erosive esophagitis [24]. 2) Increased Transient LES Relaxations (TLESRs). This has been considered as the major LES mechanisms for reflux, especially in patients with normal resting LESP [25, 26]. Under normal conditions, the LES relaxes for 3-10 seconds to allow the swallowed bolus to enter the stomach. Brief episodes of GER can occur during this transient opening in normal individuals [27]; while in patients, pathological TLESRs occur spontaneously unrelated to swallowing and esophageal peristaltic contractions, and can last longer (up to 45 seconds) [25, 26]. There is a propensity for TLESRs to occur i