消化内科胃食管反流病诊断和治疗.pptVIP

胃食管反流病(GERD Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  ●胃食管反 流病(GERD) 是指胃十二指肠 内容物反流入食 管引起烧心等反 流症状或组织损 伤 GERD occurs with stomach Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  ●反流性食管炎 (RE 是因胃、十二指肠 内容物反流入食管 引起的食管黏膜炎 症 Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  ·非糜烂性反流 病(NERD) 即内镜阴性的胃 食管反流病,是 指患者有胃食管 反流的症状,如 烧心等,但内镜 检查未见阳性表 Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  流行病学 GERD随年龄增大而增多,40-60岁多发 男女比例接近,但RE男性高于女性(2:1~ 3:1) GERD在欧美国家患病率达10%~20%, RE约占总人口的3%~4% 北京和上海人群的患病率为577%,RE为 1.92%。 Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  病因及发病机制 抗反流防御机制减弱 及反流物(酸、胃蛋白酶 十二指肠液)对食管黏 膜的攻击作用为主要发病 机制。 Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  GERD发病机理 食管清除力 蠕动 重力 ●唾液 食管黏膜屏障 胃食管屏障以 OLESP少 膈肌脚 胃排空↓ Pepsin 膈食管韧带 His角 Bile Pancreatic OTLESR I enzymes Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  抗反流屏障 胃食管交界处结构异常 相当于阀门,能有效地阻止胃内容物反流 食管下括约肌压力降低 食管下括约肌松弛 TLESR是与吞咽无关的短时间LES松 弛,可持续10-45秒。已知 TLESE是正 常人和GERD患者发生胃食管反流的主 要机制。频率受食物、吸烟、饮酒影响 Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  致LESP降低的因素 某食 此 内内 激物物增增 Ev