Diagnosis and treatment of gastroesophageal reflux disease.
Diagnosis and treatment of gastroesophageal reflux disease.
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DOI：
10.4292/wjgpt.v5.i3.105
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发表时间：
2014-08-06
期刊：
影响因子：
--
通讯作者：
Francis, Dawn
中科院分区：
文献类型：
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作者：
Badillo, Raul;Francis, Dawn
胃食管反流病（GERD）是一种常见病，在西方世界的患病率高达10%-20%。该疾病可以表现为各种症状，这些症状可以分为典型，非典型和食管外症状。对GERD特异性最高的是胃酸反流和胃灼热。在没有报警症状的情况下，这些症状可以让一个人做出推定诊断，并开始经验性治疗。在某些情况下，需要进一步的诊断测试来确认诊断以及评估并发症或症状的替代原因。GERD并发症包括糜烂性食管炎、消化道狭窄、Barrett食管、食管腺癌和肺部疾病。GERD的管理可能涉及生活方式的改变，药物治疗和手术治疗。生活方式的改变，包括体重减轻和/或床头抬高，已被证明可以改善食管pH和/或GERD症状。药物治疗包括抑酸，可通过抗酸剂、组胺受体拮抗剂或质子泵抑制剂实现。虽然大多数患者可以通过药物治疗进行有效管理，但其他患者在接受适当的术前评估后可能需要进行抗反流手术。本文就胃食管反流病的诊断和治疗方法作一综述。
Gastroesophageal reflux disease (GERD) is a common disease with a prevalence as high as 10%-20% in the western world. The disease can manifest in various symptoms which can be grouped into typical, atypical and extra-esophageal symptoms. Those with the highest specificity for GERD are acid regurgitation and heartburn. In the absence of alarm symptoms, these symptoms can allow one to make a presumptive diagnosis and initiate empiric therapy. In certain situations, further diagnostic testing is needed to confirm the diagnosis as well as to assess for complications or alternate causes for the symptoms. GERD complications include erosive esophagitis, peptic stricture, Barrett's esophagus, esophageal adenocarcinoma and pulmonary disease. Management of GERD may involve lifestyle modification, medical therapy and surgical therapy. Lifestyle modifications including weight loss and/or head of bed elevation have been shown to improve esophageal pH and/or GERD symptoms. Medical therapy involves acid suppression which can be achieved with antacids, histamine-receptor antagonists or proton-pump inhibitors. Whereas most patients can be effectively managed with medical therapy, others may go on to require anti-reflux surgery after undergoing a proper pre-operative evaluation. The purpose of this review is to discuss the current approach to the diagnosis and treatment of gastroesophageal reflux disease.