Current trends in the management of gastroesophageal reflux disease: a review.

ISRN gastroenterology Pub Date : 2012-01-01 Epub Date: 2012-07-11 DOI:10.5402/2012/391631
Sylvester Chuks Nwokediuko
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引用次数: 75

Abstract

Gastroesophageal reflux disease (GERD) is a chronic disorder of the upper gastrointestinal tract with global distribution. The incidence is on the increase in different parts of the world. In the last 30 to 40 years, research findings have given rise to a more robust understanding of its pathophysiology, clinical presentation, and management. The current definition of GERD (The Montreal definition, 2006) is not only symptom-based and patient-driven, but also encompasses esophageal and extraesophageal manifestations of the disease. The implication is that the disease can be confidently diagnosed based on symptoms alone. Nonerosive reflux disease (NERD) remains the predominant form of GERD. Current thinking is that NERD and erosive reflux disease (ERD) are distinct phenotypes of GERD rather than the old concept which regarded them as components of a disease spectrum. Non erosive reflux disease is a very heterogeneous group with significant overlap with other functional gastrointestinal disorders. There is no gold standard for the diagnosis of GERD. Esophageal pH monitoring and intraluminal impedance monitoring have thrown some light on the heterogeneity of NERD. A substantial proportion of GERD patients continue to have symptoms despite optimal PPI therapy, and this has necessitated research into the development of new drugs. Several safety concerns have been raised about chronic use of proton pump inhibitors but these are yet to be substantiated in controlled studies. The debate about efficacy of long-term medical treatment compared to surgery continues, however, recent data indicate that modern surgical techniques and long-term PPI therapy have comparable efficacy. These and other issues are subjects of further research.

当前胃食管反流病的治疗趋势综述。
胃食管反流病(GERD)是一种全球分布的上消化道慢性疾病。世界各地的发病率都在上升。在过去的30到40年里,研究结果使人们对其病理生理、临床表现和治疗有了更深入的了解。目前对胃食管反流的定义(蒙特利尔定义,2006年)不仅以症状为基础,以患者为导向,而且还包括该疾病的食管和食管外表现。这意味着,仅根据症状就可以自信地诊断出这种疾病。非糜烂性反流病(NERD)仍然是GERD的主要形式。目前的想法是,NERD和糜烂性反流病(ERD)是GERD的不同表型,而不是将它们视为疾病谱系组成部分的旧概念。非糜烂性反流病是一个非常异质性的群体,与其他功能性胃肠道疾病有显著的重叠。对于反流胃食管反流的诊断没有金标准。食管pH值监测和腔内阻抗监测为NERD的异质性提供了一些线索。尽管采用了最佳的PPI治疗,但仍有相当比例的胃食管反流患者仍有症状,这就需要研究开发新药。长期使用质子泵抑制剂引起了一些安全问题,但这些问题尚未在对照研究中得到证实。关于长期药物治疗与手术相比的疗效的争论仍在继续,然而,最近的数据表明,现代手术技术和长期PPI治疗具有相当的疗效。这些和其他问题是进一步研究的主题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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