sandhill文摘(11)

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1、AGAIssuesPracticesGuidelinesfortheDiagnosisandManagementofGERD TheFebruary19thissueoftheAmericanJournalofGastroenterologyfeaturesthepublicationofnewpracticeguidelinesforthediagnosisandmanagementofGERD. [1] TheseAGAmedicalpositionstatementsaredevelopedundertheaegisoftheAGAIns

2、tituteClinicalPracticeandQualityManagementCommitteeandprovidepreferredapproachestospecificGERDdiagnosisandmanagementscenarios. AcomprehensivereviewofthePracticeGuidelinesisrecommendedforallclinicianspracticingintheGERDfield.ThefullpublicationcanbeaccessedusingthecitationinFo

3、otnote#1. Guidelines,whicharespecificallyrelevanttoSandhillScientificrefluxmonitoringandmotilitytestingdiagnosticproductsaresummarizedasfollows:(textinsertsaresourcedfromthereferencedAGApublication[1]) GERDDiagnosis "Esophagealmanometryisrecommendedforpreoperativeevaluation,

4、buthasnoroleinthediagnosisofGERD.(Strongrecommendation,lowlevelofevidence)" "Ambulatoryesophagealrefluxmonitoringisindicatedbeforeconsiderationofendoscopicorsurgicaltherapyinpatientswithnon-erosivedisease,aspartofthe evaluationofpatientsrefractorytoPPItherapy,andinsituations

5、whenthediagnosisofGERDisinquestion.(Strongrecommendation,lowlevelofevidence)." "Ambulatoryrefluxmonitoringistheonlytestthatcanassessrefluxsymptomassociation(strongrecommendation,lowlevelofevidence)." "Performedwitheitheratelemetry capsule(usually48h)ortransnasalcatheter(24h)

6、,pHmonitoring hasexcellentsensitivity(77-100%)andspecificity(85-100%)in patientswitherosiveesophagitis;however,thesensitivityislower inthosewithendoscopy-negativerefluxsymptoms(<71%)when adiagnostictestismorelikelytobeneeded. " "Catheter-basedmonitoringallowsfortheadditionof

7、 impedanceanddetectionofweaklyacidicornon-acidreflux." NOTE:Aconsensus statement(35)inthebodyofthepublicationsuggeststhatimpedanceaddedtopHmonitoring increasesthesensitivityofrefluxmonitoringtocloseto 90%.  "Optimaluseofthesetwooptionsiscertainlydebatedasiswhether totestonor

8、offtherapy.Asatruediagnostictest(isabnormal acidexposurepresent)andforevalu