难治性胃食管反流病 RGERD.pptxVIP

Refractory Gastroesophageal reflux disease;Definition of RGERD;PPI failed in Each of the Gastrooesophageal Re?ux Disease (GERD) Groups;30%NERD fail to PPI treatment;NERD-acid,visceral sensitivity;Potential causes of PPI refractoriness in GERD;Weakly Acid Reflux;;;Poor Compliance with PPI Treatment ;Nocturnal Acid Breakthrough;Dilated intercellular spaces ;Bile Reflux;Psychological Comorbidities;New Mechanism;;Protease activated receptor 2(PAR2);Proinflammatory and Neuroinflammatory Aspects;Esophageal Eosinophilia;Erosive esophagitis may be related to small intestinal bacterial overgrowth Scandinavian Journal of Gastroenterology. 2012;Diagnosis tests;Upper Gastrointestinal Endoscopy;A new method in the diagnosis of reflux esophagitis: confocal laser endomicroscopy. GIE.2012;共聚焦激光显微内镜诊断NERD;NERD diagnosed by CLE-Dilated DIC ; Esophageal pH monitoring allow the quanti?cation of esophageal acid exposure and the assessment of the temporal relationship between symptoms and acid re?ux events. PH monitoring can be performed off PPI to test if the initial diagnosis was correct (i.e., heartburn was due to acid re?ux) or on PPI to test whether the symptoms are due to residual acid re?ux. ;Ambulatory 24h Esophageal pH Monitoring- Graphs; ;Treament of RGERD;Therapeutic options for RGERD patients;GERD and PPI;New PPIs;Histamine 2 receptor antagonist (H2RA);Promotility therapy;Transient lower esophageal sphincterrelaxation (TLESR) reducers;;Gastroesophageal reflux disease-from reflux episodes to mucosal inflammation. Nat. Rev. Gastroenterol. Hepatol.2012;;;Antire?ux Surgery;Endoscopic therapy;LINX re?ux management system;Management algorithm of GERD patient who failed PPI once daily ;Thank you for your attention!!