Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015
Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015
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DOI：
10.1007/s00535-016-1227-8
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发表时间：
2016-08-01
影响因子：
6.3
通讯作者：
Shimosegawa, Tooru
中科院分区：
文献类型：
--
作者：
Iwakiri, Katsuhiko;Kinoshita, Yoshikazu;Shimosegawa, Tooru
随着日本胃食管反流病（GERD）的报道增多，以及公众对GERD的关注度不断提高，日本胃肠病学会于2009年出版了《GERD循证临床实践指南（第1版）》。自出版以来已经过去了6年，期间日本国内出现了大量关于Barrett食管的流行病学、病理生理学、治疗以及Barrett食管的报道。综合这些报告的内容，对指南进行了全面修订，并于2015年10月出版了新版。修订版共包括流行病学、病理生理学、诊断、内科治疗、外科治疗、上消化道术后食管炎、食管外症状、Barrett食管8个项目。本文总结了这些指南，特别是与 GERD 治疗相关的部分。在本次修订中，对于严重糜烂性胃食管反流病，建议采用积极的质子泵抑制剂（PPI）维持治疗；对于轻度糜烂性胃食管反流病，或对 PPI 敏感的非糜烂性胃食管反流病，建议按需治疗或持续维持治疗。此外，定义了PPI抵抗性GERD（尽管以标准剂量PPI给药8周，但症状改善不足和/或食管粘膜破裂持续存在），并且建议每天两次标准剂量PPI、改变PPI、改变PPI给药时间、添加促动力药物、添加六君子汤（日本传统草药）和添加组胺H2受体拮抗剂它的治疗。如果经过这些治疗后仍未见改善，建议在食管疾病专家机构进行食管阻抗-pH 监测或食管测压的病理生理学评估。
As an increase in gastroesophageal reflux disease (GERD) has been reported in Japan, and public interest in GERD has been increasing, the Japanese Society of Gastroenterology published the Evidence-based Clinical Practice Guidelines for GERD (1st edition) in 2009. Six years have passed since its publication, and there have been a large number of reports in Japan concerning the epidemiology, pathophysiology, treatment, and Barrett's esophagus during this period. By incorporating the contents of these reports, the guidelines were completely revised, and a new edition was published in October 2015. The revised edition consists of eight items: epidemiology, pathophysiology, diagnosis, internal treatment, surgical treatment, esophagitis after surgery of the upper gastrointestinal tract, extraesophageal symptoms, and Barrett's esophagus. This paper summarizes these guidelines, particularly the parts related to the treatment for GERD. In the present revision, aggressive proton pump inhibitor (PPI) maintenance therapy is recommended for severe erosive GERD, and on-demand therapy or continuous maintenance therapy is recommended for mild erosive GERD or PPI-responsive non-erosive GERD. Moreover, PPI-resistant GERD (insufficient symptomatic improvement and/or esophageal mucosal break persisting despite the administration of PPI at a standard dose for 8 weeks) is defined, and a standard-dose PPI twice a day, change in PPI, change in the PPI timing of dosing, addition of a prokinetic drug, addition of rikkunshito (traditional Japanese herbal medicine), and addition of histamine H2-receptor antagonist are recommended for its treatment. If no improvement is observed even after these treatments, pathophysiological evaluation with esophageal impedance-pH monitoring or esophageal manometry at an expert facility for diseases of the esophagus is recommended.