消化系统学习资料胃食管反流病20163八年制ppt课件.pptVIP

胃食管反流病;Which of the following statements is true?;Regarding the symptoms of GERD, which one is false?;What is the most common condition associated with GERD?;Which of the following usually raise the incidence of GERD?;When should a patient consider surgery for GERD?;GERD Definition(Gastroesophageal Reflux Disease);Pathogenesis;Anti-Reflux Barrier;Transient LES Relaxation;Esophageal Acid Contact;Incidence and Background;Heartburn – burning or tightness behind the sternum or in the epigastric area. Acid regurgitation – sour or bitter taste in the throat or mouth. Water brash – a hot sensation in the stomach followed by a large amount of watery liquid in the mouth. Dysphagia - difficulty swallowing or painful swallowing (odynophagia). The sensation of a lump in the throat or food getting “stuck” after swallowing. Asthma, laryngitis and chronic cough are unusual symptoms, but can be caused by GERD.;Klauser A, et al. Lancet 1990;335:205-8.;烧心和反流症状与食管pH监测异常;GERD Symptoms in Patients With Adenocarcinoma of the Esophagus or Cardia;胸痛、上腹痛、上腹烧灼感、嗳气等为 胃食管反流病的不典型症状;;Symptoms;Symptoms made worse…;食管炎可无症状(asymptomatic esophagitis);Distribution of grades of reflux esophagitis in symptomatic and asymptomatic patients;胸痛患者需先排除心脏的因素才进行反流的评估;GERD可伴随食管外症状， 包括咳嗽、咽喉症状、哮喘及牙蚀症等;GERD症状小结;Diagnostic Tests;胃食管反流病——诊断;胃食管反流病——诊断;2013 ACG指南：GERD诊断手段及应用汇总;质子泵抑制剂试验简便有效， 可作为GERD酸反流的诊断试验1;PPI试验的敏感性和特异性;食管反流监测是GERD的有效检查方法。未使用质子泵抑制剂者可选择单纯pH监测，若正在使用质子泵 抑制剂则需加阻抗监测以检测非酸反流。;食管反流监测的意义和指征;胃食管反流病;Prompt Upper Endoscopy Is an Appropriate Initial Management in Uninvestigated Chinese Patients with Typical Reflux Symptoms;内镜检查正常的患者其检查过程中 不推荐常规进行食管活检 ;Los Angeles Classification;Los Angeles Classification;Los Angeles Classification;Los Angeles Classification;Complications of GERD- Barrett’s Esophagus;GI Motility online (May 2006); 食管钡剂造影不推荐为GERD的诊断方法; 食管测压可了解食管动力状态，用于术前评估， 不能作为GERD的诊断手段。;胃食管反流病——诊断和鉴别诊断流程;Treatment;How is GERD treated?;Lifestyle Changes;Medications;Medications;;Efficacy of proton pu