GERD讲座 常熟2012 课件.pptVIP

有关胃食管返流病研究的几个问题;胃食管反流病一个消化科医生广泛关注的话题;影响胃食管反流病的因素;消化科专家如是说;一项网上调查;GERD的定义;2009年胃食管反流病专家论坛;GERD诊断的困惑;在全国五家医院进行多中心研究.所有入组患者填写GerdQ问卷表.以胃镜检查、24h食管pH监测和PPI试验其中任何一项阳性作为GERD的诊断标准,评价GerdQ的诊断价值.以拟定PPI试验诊断标准与胃镜和食管pH监测的诊断相比较,并优化PPI试验的诊断标准. 结果 拟定PPI试验诊断的敏感度为0.6627,特异度为0.4872.经统计分析,以PPI治疗1周最后3d烧心、反流症状总评分较治疗前相比下降3分为优化PPI试验诊断标准,诊断的敏感度为0.3787,特异度为0.8077,阳性预测值为0.8101,阴性预测值为0.3750,Youden指数最大为0.1864.经人群矫正,GerdQ取临界值为10分时,Youden指数达到最大0.1080,诊断的敏感度为0.6690,特异度为0.4390.50岁以上女性患者随着评分的增高,问卷诊断价值下降. 结论 GerdQ具有肯定的诊断价值.但在临床工作中,对特殊人群中症状突出而PPI诊断性治疗反应不佳的患者,GERD的诊断应慎重.PPI试验的评分以治疗1周最后3d为佳.;《中国胃食管反流病治疗共识意见》 ;胃食管反流病治疗共识意见;后果严重;;食管内多通道阻抗技术;一项研究的提示;;pH-阻抗联合测试的意义;多通道腔内阻抗 (MII);;;;食管阻抗测量技术原理;高阻抗;Impedance ;食团运动时的阻抗变化;食团完整的传输过程;Time ;;;阻抗测量系统组成;;*;阻抗-pH 检测VS单纯pH检测;;阻抗-pH 检测VS单纯pH检测;24小时pH-阻抗检测系统;Inder Mainie, R. Tutuian D. O. Castell; Medical College of SC; Symptoms on PPI Therapy Associated with Nonacid, Acid or No Reflux; ACG Presentation; October 2004;Acid and Nonacid Reflux in Patients with Persistent Symptoms Despite Acid Suppressive Therapy. A Multicentre Study Using Combined Ambulatory Impedance-pH Monitoring; Maine et al; Gut 2006; 55:1398;有典型症状的病人 N=58;;非典型症状的病人 N=43;联合阻抗-pH检测期间有症状的病人 N=200;在服抗酸药期间做联合阻抗-pH检测;218名PPI治疗后症状持续的患者;成人病人;pH-阻抗联合测试的意义;国外 GERD 治疗方案 ; 联合阻抗-pH指导治疗 ;值得探讨的几个课题;中国问卷与罗马基金会问卷的比较;防止PPI??度使用：全球面临的挑战。;PPI的副作用;PPI可引起肺炎;胃底腺息肉和胃癌;心梗再发危险和因急性冠脉综合征;PPI应用显著增加CDAD危险 ;增加骨折风险;PPI与SIBO和IBS;GERD-PPI-SIBO-IBS;;PPI和小肠细菌过度生长;GHBTs were given to 450 consecutive patients (200 with gastroesophageal reflux disease who received PPIs for a median of 36 months; 200 with irritable bowel syndrome [IBS], in absence of PPI treatment for at least 3 years; and 50 healthy control subjects that had not received PPI for at least 10 years). Each subject was given a symptoms questionnaire. SIBO was detected in 50% of patients using PPIs, 24.5% of patients with IBS, and 6% of healthy control subjects; there was a statistically significant difference between patients using PPIs and those with IBS or healthy control