医药代表学术培训-难治性GERD的处理（精华版）.pptVIP

Eosinophilic Esophagitis: Endoscopy From Gonsalves N et al. Gastrointest Endosc 2006;64:313-9. 内镜特点： 多发食管环形改变、 纵性沟槽、或针尖白色渗出等 食物食管嵌塞 From Gonsalves N et al. Gastrointest Endosc 2006;64:313-9. Histologic Features of Eosinophilic Esophagitis 病理： 嗜酸细胞15－20个/HP。 外周血中嗜酸细胞增高不常见。 嗜酸性食管炎的治疗 激素治疗 抗过敏治疗 PPI可缓解症状 其它动力性疾病误诊为GERD 贲门失迟缓症 “胡桃夹”食管 功能性消化不良 难治性“GERD”的处理流程 考虑难治性GERD PPI依从性及剂量？ 调整剂量、品种及时间 胃镜检查 异常 正常 与酸无关疾病 嗜酸性食管炎 药片性食管炎 与酸相关疾病 反流性食管炎 Barrett‘s 食管 相应的治疗 加强抗反流治疗 或抗反流手术 食管压力测定 pH-阻抗测定 NERD(酸反流) NERD(非酸反流) 高敏感食管 功能性烧心 加强抗反流治疗 或抗反流手术 中枢性调节剂 yse ＮＯ 总 结 对难治性“GERD”，首先了解患者的用药依从性及用药剂量。 PPI加倍或换用其它种类PPI---主要策略 食管腔内pH-阻抗监测是难治性“GERD”进一步分层诊断的最佳手段。 动力障碍是难治性“GERD”重要因素之一 功能性烧心：中枢调节剂是治疗的关键。 谢谢 * * The CYP2C19 and CYP3A4 metabolic pathways are in common for all PPIs in the formation of mainly inactive metabolites. However, there are subtle differences, especially in the further transformation of the demethylated pantoprazole which is through a conjugation pathway, and also in the spontaneous non-enzymatic formation of the reduced form of rabeprazole, the thioether metabolite, which however is just a minor metabolite of rabeprazole. * * Charbel S, Khandwala F, Vaezi MF. The role of esophageal pH monitoring in symptomatic patients on PPI therapy. Am J Gastroenterol 2005; 100: 283–9. * * In the 13 patients, 916 liquid-containing reflux episodeswere recorded. Amongst these, 125 (13.6%) were acid reflux and 791 (86.4%) non-acid reflux. Amongst the nonacid reflux, 752 (82.1%) were weakly acid reflux and 39 (4.3%) weakly alkaline reflux. A symptom was considered to be associated with reflux if a reflux episode was detected 5 min prior to the symptoms occurring. A total of 171 symptoms was recorded by patients during the study, 76 (44.4%) of which, were related to liquid reflux and 76 (8.3%) of the total 916 liquid reflux episodes were accompanied by reflux symptoms. Eight (4.7%) of the 171 symptoms were related to acid reflux, 68 (39.8%) were related to non-acid reflux and the caus