胃食道逆流症.ppt

外科手術 Comparable rates of maintenance of remission and quality of life to PPI therapy 10年後有60%又需要內科藥物治療. Mortality rate 1% 併發症多: dysphagia, bloating, diarrhea, nausea, flatulence 理想的治療時間 LA class A B: 4 M ? LA class C D: 1 Yr ? Consideration: With GU ? Recurrent GERD ? Response to PPI Medical Therapy (IV) PPI對GERD的症狀緩解及促進黏膜癒合 都很有效 長期使用PPI, 基本上是安全的 副作用:僅有5%會有腹瀉.頭痛等… 長期使用:少數會有B12吸收不良,小腸細菌增生,社區型肺炎,C. Difficele感染,以及Hip fracture Conclusions (1) GERD 有逐漸上升之趨勢 PPI 是最好的藥物. 需要多少劑量,治療多久?因人而異! Refractory GERD: 一天吃兩次, or 換新一代之 PPI GERD is a “4C” disease “C”ommon (很常見) “C”hronic (慢性病) “C”omplicated (可能有併發症) “C”ontrollable (可以控治) Conclusions (2) PPI: 在GERD 扮演何種角色 ? 倚天既出 誰與爭鋒 ！ Thank you for your attention Author: Bardhan KD et al Title: Duodenal ulcer and gastroesophageal reflux disease today: long-term therapy - a sideways glance Source: Yale J Biol Med; 69: 211-224 It is common experience that reflux disease is seen more frequently. The figure shows the number of new patients seen in the Rotherham center each year from 1976 to 1994 with GERD (erosive and non-erosive disease), duodenal and gastric ulcer. The rising numbers of patients with GERD is striking. As this was not a formal epidemiological study, conclusions on changing prevalence have to be tentative and limited. The annual number of endoscopies since 1980 has not changed, so the rise cannot be entirely explained by increasing use of diagnostic methods. Greater awareness of GERD, particularly of non-erosive disease, presumably contributes. However, it is difficult to avoid the possibility that at least a part of the rising numbers results from a true increase in prevalence. Author: Jones RH et al Title: Gastro-esophageal reflux disease in primary care in Europe: clinical presentation and endoscopic findings Source: Eur J Gen Pract; 1: 149-154 Heartburn is the most frequently experienced symptom of GERD and in 86% of the patients in European general practices dia