gerd最诊治进展ppt课件.ppt

* 可改善症状 * * * 国内10家医院多中心研究显示反流症状问卷调查对反流病诊断阳性符合率为88.07%。 * 多中心研究发现PPI试验，即双倍剂量PPI治疗1周，对胃食管反流病诊断阳性符合率为81%。说明问卷调查及PPI试验对反流病诊断具有较大价值，如两者联合意义更大。 * * * 下面我想简单地谈一下反流病诊断及治疗的体会。长期以来胃镜及24小时pH监测一直是反流病主要的检查手段。但是，是不是所有患者均需这些昂贵复杂的检测呢？因为胃镜、pH监测并不能解决所有反流病诊断问题，花费又大，所以目前倾向于仔细分析患者症状特点，进行反流问卷调查，在此基础上对无报警症状患者进行治疗性试验。 * * * * * 图中EO，BO分别改为EE与BE * 93. The frequency of acid-reflux symptoms is directly related to the time that the esophageal pH is below 4 The frequency of acid-reflux symptoms is directly related to the degree of esophageal acid exposure over the 24-hour period. In a study of 190 patients with heartburn and acid regurgitation, the frequency of these symptoms was proportional to the percentage of time that the esophageal pH was below 4 during each 3-hour period studied.68 Even patients who experienced only occasional symptoms of heartburn and acid regurgitation were shown to have excess esophageal acid exposure for approximately 15 hours of the day, comparedwith healthy controls. There is thus a clear need for effective control of 24-hour intraesophageal acidity above pH 4 to achieve reliable resolution of symptoms, even if they appear to be mild. * * * * * * * 胃酸过多可导致上述诸多疾病及症状的出现，因此抑酸是治疗酸相关性疾病的关键。胃内pH4持续时间与反流性食管炎愈合率的研究结果表明，胃内pH值维持在4以上的时间与8周后患者的治愈率呈线性相关，时间越长，治愈率越高，可见维持胃内pH值＞4是改善症状和提高愈合率最重要的一个环节。 * 84. PPIs control acid secretion by directly inhibiting the proton pump The efficacy of PPIs in managing GERD is a result of their inhibitory action on the proton pump, the H+, K+-ATPase of the gastric parietal cell. The activated proton pump catalyses the final step in gastric acid secretion – the exchange of H+ ions (protons) in the cytoplasm of the parietal cell with K+ ions in the canalicular space. Inhibition of this exchange prevents the accumulation of acid, in the form of H+ ions, in the canalicular space, and thus prevents the secretion of this acid into the lumen of the stomach. Due to the action of the proton pump under normal physiological conditions, the canalicul