GE胃食管反流病共识.ppt

* * * * 呼吸并发症与胃食管反流病的关系Association Between Gastroesophageal Reflux and Respiratory Complications 麻醉后吸入性肺炎 Simpson (1847) 肺疾病与食管缺陷 Mermod (1887) 支气管收缩反射与胃扩张 Bray (1935) Mendelson syndrome Mendelson (1946) GER和溃疡的关系 Cherry and Margulies (1968) 烧心症状指数与内镜下发现的比较 症状指数（％） 患者数（n＝67） Weiner et al. Am J Gastroenterol 1988 不同GERD组患者24hr食管pH检测的异常率 患者（％） Martinez et al. Aliment Pharmacol Ther 2003 Cervero F, Laird JM. Visceral pain. Lancet 1999;353(9170):2145–2148. NERD 、EE和 BE病人酸反流时间的分布 Distribution of acid reflux times in patients with nonerosive esophageal reflux disease (NERD), erosive esophagitis (EE), and Barretts esophagus (BE). 与酸反流事件不相关的“烧心” 潜在机理： 非酸相关刺激 食管运动、非酸性反流 pH下降 4.0 Fass R. Am J Gastroenterol 2001 咽喉反流症状 Patients with LPR often take several months to resolve their symptoms and laryngeal abnormalities once appropriate therapy is initiated Although many patients have symptomatic improvement after 2 months of therapy, laryngeal examination findings continue to improve for up to 6 months after initiation of antireflux therapy. 咽喉反流症状 One study showed that approximately 50% of LPR patients on twice-daily PPI therapy have symptomatic improvement at 2 months, and an additional 22% improve from 2 to 4 months after initiating therapy Even fundoplication surgery does not result in immediate improvement in LPR, and symptoms and examination findings continue to show improvement from 4 to 14 months after fundoplication 哮喘与胃食管反流 Gastroesophageal reflux (GER) and asthma are common in the general population, with GER existing together with asthma in up to 80% of asthmatics The frequency with which GER actually triggers asthma is not known No clinical test at present can reliably confirm the diagnosis of GER -triggered asthma 哮喘与胃食管反流 A patient-recognized association of GER with respiratory symptoms may be a reliable predictor of GER -triggered asthma Proton pump inhibitors (PPIs) may improve respiratory symptoms in some asthmatics (perhaps nocturnal