86胃食管反流病

zhondsfsfsf胃食管反流病GERD中山医院消化内科-10级研究生缪青ZHONGSHANHOSPITALFUDANUNIVERSITY中山医院消化内科ContentsTitleinhere4.Diagnosis2.Epidemiology3.Symptoms1.Definition5.Treatment食常见病管外表现复杂多样--涉及多个系统、器官严重生活质量，甚至危急生命误诊率高zhondsfsfsf定义DefinitionZHONGSHANHOSPITALFUDANUNIVERSITY中山医院消化内科DefinitionGERD:由胃内容物反流引起的不适症状和(或)并发症的一种疾病。可导致食管炎和咽、喉、气道等食管以外的组织损害镜下可表现为食管黏膜糜烂、溃疡等炎症病变,称反流性食管炎中山医院消化内科DefinitionGERD:也有部分患者内镜下可无反流性食管炎表现,这类称为内镜阴性的GERD。zhondsfsfsf流行病学资料EpidemicaldataZHONGSHANHOSPITALFUDANUNIVERSITY中山医院消化内科Epidemicalfeatures•美国(unit:%)7-10%患病率7.0%-14.0%44%的人至少每月有1次反流症状20%的人至少每周有1次反流症状44%20%西方国家十分常见：患病率为7.0%～14.0%美国人中：20%的人至少每周有1次反流症状美国人中：44%的人至少每月有1次反流症状•美国•西方中山医院消化内科Epidemicalfeatures日本学者对1996年至2006年10年间关于GERD症状日本发病率文献进行总结发现患病率从6.6%到37.6%之间不等6.6%-37.6%？中山医院消化内科Epidemicalfeatures北京上海江苏舟山西安安徽铜陵0%10%20%30%40%50%29.3%7.6%9.5%16.9%14.6%我国,北京、上海、江苏舟山、西安地区及安徽铜陵地区GERD症状发生率分别为29.3%、7.6%、9.5%、16.9%及14.6%。中山医院消化内科Epidemicalfeatures中华普外科手术学杂志2010年8月第4卷第3期年龄段统计--解放军第二炮兵总医院22%17%1.2%0.5%21-40岁1-20岁0.5%1.2%17%22%61-80岁81-120岁58%41-60岁58%zhondsfsfsf症状SymptomZHONGSHANHOSPITALFUDANUNIVERSITY中山医院消化内科Symptoms症状食管刺激症状食管反流症状不典型症状RetrosternalpainHeartburn咳嗽、咳痰、喘息、憋气、胸痛、咽部异物感、吞咽困难、喉部发紧甚至窒息感等•2种典型症状：食管反流症状+食管刺激症状•不典型症状regurgitation中山医院消化内科Symptoms拓展RecurrencegenerallyrecuroncemedicaltherapyisstoppedExaminationEndoscopicexaminationmayormaynotfindesophagitisLong-termCom.long-termcomplicationsareBarrett’sesophagusandinsomecasesesophagealadenocarcinomaQualityoflifesymptomscansignificantlyimpairthequalityoflife中山医院消化内科Epidemicalfeatures56.41%54.44%52.17%50.49%47.83%40.63%32.25%31.66%30.57%28.11%26.92%18.93%18.24%18.15%17.26%16.07%15.48%9.17%0.0%10.0%20.0%30.0%40.0%50.0%60.0%中华普外科手术学杂志2010年8月第4卷第3期中山医院消化内科Symptoms—进展2006年GERD蒙特利尔共识意见认为:反流性咳嗽综合征、反流性喉炎综合征、反流性哮喘综合征和反流性牙侵蚀综合征与GERD明确相关而咽炎、鼻窦炎、特发性肺纤维化和复发性中耳炎与之可能相关。近年来很多文献报道成年人哮喘与GERD存在明显相关性,Molle等发现存在持续性哮喘的儿童和青少年胃食管反流患病47.3%,患病率显著高于正常儿童青少年。我们通过动物实验也证实:胃内容物可经咽反流至喉、气管.zhondsfsfsf诊断DiagnosisZHONGSHANHOSPITALFUDANUNIVERSITY中山医院消化内科Diagnosis阴性阳性质子泵抑制剂试验阳性确诊胃镜检查和/或24hpH监测应用双倍剂量PPI7d对怀疑GERD的患者进行诊断性治疗,症状好转视为阳性zhondsfsfsf治疗TreatmentZHONGSHANHOSPITALFUDANUNIVERSITY中山医院消化内科TreatmentLifestyleChangeTreatmentusuallyincludes:•Lifestyle•Medicaltreatment•Endoscopictreatment•TIFEndoscopetreatment腹腔镜胃底折叠术(TIF,TransoralIncisionlessFundoplication)和其他手术MedicineSurgeryEndoscope中山医院消化内科Treatment•Adequateoreffective90%patients.•mustbemaintainedlongtermbecausecessationofmedicine90%recurrenceofsymptoms•long-termdrugtherapyisassociatedwithissuesofcost,compliance,andlong-termsafetyMedicalTreatment中山医院消化内科TreatmentEndoscopicTreatmentToimprovetheantirefluxbarrierfunction1.injectionoffillermaterialsintotheLESandcardia2.deliveryofradiofrequencyenergytotheLESandcardia3.creationofgastroplications中山医院消化内科Treatment胃底折叠术是治疗GERD的经典术式,已在国外开展50余年,被证实治疗效果满意。手术抗反流的效果在于降低酸暴露,恢复下食管括约肌的功能,改善受损的食管蠕动功能,从而阻止反流,防止微吸入和迷走神经反射,这两种因素在改善GERD相关性呼吸症状中起作用。Surgery•mortalityrateofapproximately0.2%,•withadditionalmorbidityincludingdysphagia,gas-bloatsyndrome,andpostprandialfullness手术效果中山医院消化内科othertechniques(understudy)•His-Wizinfrasphinctericplicator,useofmagnetstoaugmenttheesophagealsphincter•implantationofanon-demanmicrostimulatorintotheLEStoincreaseLESpressure中山医院消化内科STRETTA射频治疗是一种内镜下的微创治疗,通过热能治疗后增加下食管括约肌厚度,灭活神经末梢,迷走神经受体的失活,胶原组织收缩,从而增加下食管括约肌厚度和压力,减少一过性下食管括约肌松弛,起到防止胃食管反流的效果。OTHERTECHNIQUES(UNDERSTUDY)中山医院消化内科此操作简捷、安全、创伤小,国外已开展约10年,多项研究已经证明其安全性,中远期效果满意。它对于药物难治性、惧怕手术或者抗反流手术后复发患者是一种有效治疗手段,但是国外仅把该项治疗用于针对反酸、烧心等消化道症状的治疗。和腹腔镜胃底折叠术及药物治疗互相补充,极大丰富了GERD的治疗手段。OTHERTECHNIQUES(UNDERSTUDY)中山医院消化内科79.1%13.6%Nissen胃底折叠术治疗110例患者随访6～24个月疗效满意疗效欠佳31.9%43.1%20.6%4.4%射频治疗320例患者随访24～44个月基本痊愈显效有效无效OTHERTECHNIQUES(UNDERSTUDY)中山医院消化内科•Prospectiverandomizedcontrolledtrialofaninjectableesophagealprosthesisversusashamprocedureforendoscopictreatmentofgastroesophagealrefluxdisease•endoscopicimplantationofaninjectableesophagealprosthesis,•theGatekeeperRefluxRepairSystem(GK)SurgEndosc(2010)24:1387–1397DOI10.1007/s00464-009-0784-9中山医院消化内科•endoscopicimplantationofaninjectableesophagealprosthesis,•theGatekeeperRefluxRepairSystem(GK)中山医院消化内科Gatekeeperprocedure:•aTheesophagealwallisaspirated.•bNormalsalineisinjectedintothesubmucosallayer.•cApocketiscreatedintothesubmucosallayer.•dTheprosthesisisimplantedinthepocket.•eHydratedprosthesesinsitu24hafterimplantationareshown中山医院消化内科中山医院消化内科•notclinicallymeaningful.•nostatisticallyorclinicallysignificantdifferencesinoutcomeswereobservedbetweenthetreatmentgroupandthecontrolgroupat6monthscomparedwithbaseline•Forthisreason,thestudywasterminatedearly.中山医院消化内科•TheconceptofendoluminaltreatmentforGERDcontinuestobeappealingbecauseitfocusesongastroesophagealrefluxcontrolandnotjustacidsecretorycontrol.zhondsfsfsfThankYou!中山医院消化内科10级研究生缪青ZHONGSHANHOSPITALFUDANUNIVERSITY