难治性胃食管反流病RGERD__培训课件.pptxVIP

Refractory Gastroesophageal reflux diseaseDefinition of RGERDRGERD:Patients who are unresponsive to 4-8 weeks treatment with PPIs twice daily or esophageal injury caused by RE can’t to be healing. —Richter JE Natl Clin Gastroenterol 2007;4:658Others suggest that lack of satisfactory symptomatic response to PPI once a day is suf?cient to consider patients as PPI failures. Any attempt to narrow the de?nition of refractory GERD might exclude many true sufferers. ——Hershcovici T et al. Best Practice Research Clinical Gastroenterology 2010 (24)923-936 Remains an area of controversyGERDNERD60-70% EE 20-30% Barrett′s oesophagus6-10% Failure on PPI qd40-50%Failure on PPI qd6-15%Failure on PPI qd20%PPI failure patients PPI failed in Each of the Gastrooesophageal Re?ux Disease (GERD) Groups——Fass et al. Aliment Pharmacol Ther 2005; 22(2):79-94.30%NERD fail to PPI treatmentNERD-acid,visceral sensitivityPotential causes of PPI refractoriness in GERDNeurogastroenterol Motil (2012) 24, 697–704 Weakly Acid RefluxThe prevalence of weakly acidic reflux in refractory GERD is 30-40%. When the esophageal pH falls by ≥ 1 unit, but remains ＞4, it is considered “weakly acidic reflux”.Gut,2004,53:1024-1031Esophageal HypersensitivityPotential factors contributing to the spectrum of reflux perception in patients with GERD . Esophageal receptor upregulation and/ or enhanced signalingPhysiological stressors, sensitization of spinal sensory neuronsAM J Gastroenterol ,2012,107, 8-15. GastroparesisDelayed gastric emptying (gastroparesis) may be a factor associated with severe reflux, dyspepsia, or both. Gastroparesis, concomitant in 25% of patients with gastroesophageal reflux disease (GERD), has been shown to improve after Nissen fundoplication. SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES?，2008，22 ?（11）: 2440-2444Poor Compliance with PPI Treatment Compliance to treatment and proper dosing are important. Timing and frequency of dosing are critical for maximum ef?cacy of th