胃食管反流病参考课件.pptVIP

* 当GERD患者出现以下警报症状时，需进一步的检查以排除恶变的可能性：吞咽困难，声音嘶哑，出血，体重减轻，正规治疗无效以及非心源性胸痛。 * Author: Dent J et al Topic: An evidence-based appraisal of reflux disease management - the Genval Workshop Report Source: Gut; 44 (Suppl 2): S1-S16 1999 This chart summarises the conclusion from an evidence-based workshop which evaluated major clinical strategies for the management of the full spectrum of gastro-esophageal reflux disease, with an emphasis on medical management. The disease was defined by the presence of esophageal mucosal breaks or by the occurence of reflux induced symptoms severe enough to impair quality of life. * 这是GERD诊断步骤的流程图。有临床症状的GERD患者可进行经内镜检查或服用洛赛克诊断。若为阴性者可互换形式进行诊断，为阳性者即可确诊。内镜检查和Losec试验均为阴性者可行24小时pH监测诊断。 * * Author: Paulus HK Topic: Gastroenterological endoscopy: a compendium of slides Source: Gütersloher Druckservice GmbH, Gütersloh 1997 The different stages of reflux esophagitis are classified by scheme established by Savary-Miller in 1977: Stage 1 is marked by single or multiple non-confluent erythmatic changes in the mucosa, sometimes with stains, sometimes diverging in stripes covered with a white exudation (1,2). 1. Savary-Miller, in Der ?sophagus. Lehrbuch und endoskopischer Atlas 1997. Solothurn, Gassmann: 750-55 2. Siewert JR et al, Z Gastroenterologie 1986; 24: 381-395 * 食管炎的内镜下分级现在比较公认的是洛杉矶分级。 A级为粘膜破损，但不超过5mm B级为粘膜破损中至少有一处5mm，但破损无融合， C级为破损有融合，但未形成环状 D级为破损形成环状，至少是75%的食管炎 * GERD的诊断可包括临床诊断，炎症诊断和实验室诊断等。临床诊断主要根据典型的和不典型的症状，以及洛赛克试验。方法为Losec 20mg bid，为期一周，准确率高，且诊治同步。 * 这是GERD诊断步骤的流程图。有临床症状的GERD患者可进行经内镜检查或服用洛赛克诊断。若为阴性者可互换形式进行诊断，为阳性者即可确诊。内镜检查和Losec试验均为阴性者可行24小时pH监测诊断。 * 反流性食管炎内镜下洛杉矶分级 Mucosal breaks confined to the mucosal fold, each no longer than 5 mm At least one mucosal break longer than 5 mm confined to the mucosal fold but not continuous between two folds Mucosal breaks that are continous between the tops of mucosal folds but not circumferential Extensive mucosal breaks engaging at least 75% of the esophageal circumference Grade A Grade B Gr