gastroesophageal reflux disease

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1、GastroesophagealRefluxDiseaseProfessorofMedicineClevelandClinicLernerCollegeofMedicineofCaseWesternReserveUniversityDepartmentofGastroenterology&HepatologyTaussigCancerCenterUSAGaryW.Falk,M.D.,M.S.DisclosuresGrantsupportNIDDKNCIAstraZenecaTakedaGivenimagingConsultantAstraZenecaNycomedOlympusEthic

2、onGastroesophagealRefluxDiseaseWhatarecurrentworkingdefinitions?WhatispathophysiologyofGERDWhatisthecurrentdiagnosticstrategy?Whatisarationaltreatmentstrategy?GastroesophagealRefluxDiseaseWhatarecurrentworkingdefinitions?WhatispathophysiologyofGERDWhatisthecurrentdiagnosticstrategy?Whatisarationa

3、ltreatmentstrategy?GERD:MontrealDefinitionAconditionwhichdevelopswhentherefluxofstomachcontentscausestroublesomesymptomsand/orcomplications>2heartburnepisodes/weekAdverselyaffectanindividual’swellbeingFromVakilNetal.AmJGastroenterol2006;101:1900-20.MontrealClassificationofGERDFromVakilNetal.AmJGa

4、stroenterol2006;101:1900-20.MontrealGERDConsensusConference:AtypicalSymptomsGERD&extraesophagealsymptomsareassociatedExtraesophagealsymptomsrarelyoccurinabsenceoftypicalGERDsymptomsExtraesophagealsymptomstypicallymultifactorialDatasubstantiatingbeneficialeffectoftreatmentweakFromVakilNetal.AmJGas

5、troenterol2006;101:1900-20.GastroesophagealRefluxDiseaseWhatarecurrentworkingdefinitions?WhatispathophysiologyofGERDWhatisthecurrentdiagnosticstrategy?Whatisarationaltreatmentstrategy?PathogenesisofGERDImpairedEsophagealClearanceDecreasedSalivationImpairedTissueResistanceDecreasedLESRestingToneDe

6、layedGastricEmptyingBileRefluxHiatalHerniaLESDuodenumDifferentRefluxMechanismsWithHiatalHernia*P<0.001.†P0.005.FromvanHerwaardenetal.Gastroenterology.2000;119:1439-1446.**†PatientsWithoutHiatalHernia(n=10)PatientsWithHiatalHernia(n=12)TLESRsLowLESPStrain+LowLESP020406080100RefluxEpisodes(%)Rela

7、tionshipBetweenBMI&TLESrFromWuJCetal.Gastroenterology2007;132:883-9.GastroesophagealPressureGradients&GERDFromdeVriesDRetal.AmJGastroenterol2008;103:1349-54.13DurationofEsophagealAcidandBileExposureAffectsGERDSeverity*