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ID:56335417
大小:7.16 MB
页数:45页
时间:2020-06-11
《难治性胃食管反流病RGERD.ppt》由会员上传分享,免费在线阅读,更多相关内容在应用文档-天天文库。
1、RefractoryGastroesophagealrefluxdiseaseDefinitionofRGERDRGERD:Patientswhoareunresponsiveto4-8weeks'treatmentwithPPIstwicedailyoresophagealinjurycausedbyREcan’ttobehealing.—RichterJENatlClinGastroenterol2007;4:658OtherssuggestthatlackofsatisfactorysymptomaticresponsetoPPIonceaday
2、issufficienttoconsiderpatientsasPPIfailures.AnyattempttonarrowthedefinitionofrefractoryGERDmightexcludemanytruesufferers.——HershcoviciTetal.BestPractice&ResearchClinicalGastroenterology2010(24)923-936RemainsanareaofcontroversyPPIfailedinEachoftheGastrooesophagealRefluxDisease(GERD)
3、GroupsGERDNERD60-70%EE20-30%Barrett′soesophagus6-10%PPIfailurepatientsFailureonPPIqd40-50%FailureonPPIqd6-15%FailureonPPIqd20%——Fassetal.AlimentPharmacolTher2005;22(2):79-94.30%NERDfailtoPPItreatmentNERD-acid,visceralsensitivityPotentialcausesofPPIrefractorinessinGERDNeurogastro
4、enterolMotil(2012)24,697–704MechanismWeaklyacidrefluxNABDilatedintercellularspacesDGEREsophagealhypersensitivityGastroparesisPoorcompliancewithPPItreatmentPsychologicalWeaklyAcidRefluxTheprevalenceofweaklyacidicrefluxinrefractoryGERDis30-40%.WhentheesophagealpHfallsby≥1unit,butr
5、emains>4,itisconsidered“weaklyacidicreflux”.Gut,2004,53:1024-1031EsophagealdistensionPersistentimpairedmucosalintegrityEsophagealhypersensitivityEsophagealHypersensitivityAMJGastroenterol,2012,107,8-15.Esophagealreceptorupregulationand/orenhancedsignalingPhysiologicalstressors,s
6、ensitizationofspinalsensoryneurons.PotentialfactorscontributingtothespectrumofrefluxperceptioninpatientswithGERDGastroparesisDelayedgastricemptying(gastroparesis)maybeafactorassociatedwithseverereflux,dyspepsia,orboth.Gastroparesis,concomitantin25%ofpatientswithgastroesophagealr
7、efluxdisease(GERD),hasbeenshowntoimproveafterNissenfundoplication.SURGICALENDOSCOPYANDOTHERINTERVENTIONALTECHNIQUES,2008,22(11):2440-2444PoorCompliancewithPPITreatmentCompliancetotreatmentandproperdosingareimportant.Timingandfrequencyofdosingarecriticalformaximumefficacyofthemedi
8、cation.PatientsdosedoptimallythePPIs(%)Properdo
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