Ramakrishnan Amarnath, Katz Philip O
Division of Gatstroenterology and Hepatology, Graduate Hospital, Suite 501, Pepper Pavilion, 1800 Lombard Street, Philadelphia, PA 19146, USA.
Curr Gastroenterol Rep. 2002 Jun;4(3):218-24. doi: 10.1007/s11894-002-0066-3.
The burden of gastroesophageal reflux disease (GERD) results from its widespread prevalence and the unfavorable impact of its symptoms on well-being and quality of life. Whereas abnormalities of the antireflux barrier (lower esophageal sphincter) are important in the pathophysiology of GERD, pharmacologic therapy for GERD is based on suppression of acid, which is responsible for the majority of the symptoms and for epithelial damage. Proton pump inhibitors (PPIs) are the agents of choice for achieving the goals of medical therapy in GERD, which include symptom relief, improvement in quality of life, and healing and prevention of mucosal injury. As a class, these drugs are extremely safe. The newest PPI, esomeprazole, brings a statistically significant increase in healing of mucosal injury and symptom relief in patients with erosive esophagitis, compared with omeprazole and lansoprazole. This article reviews the role of medical therapy in the short- and long-term management of symptomatic patients with or without erosive esophagitis, including extraesophageal presentations, GERD during pregnancy, and Barrett's esophagus. Management of refractory patients is addressed.
胃食管反流病（GERD）的负担源于其广泛的患病率以及症状对健康和生活质量的不利影响。虽然抗反流屏障（食管下括约肌）异常在GERD的病理生理学中很重要，但GERD的药物治疗基于抑制胃酸，胃酸是导致大多数症状和上皮损伤的原因。质子泵抑制剂（PPI）是实现GERD药物治疗目标的首选药物，这些目标包括缓解症状、改善生活质量以及治愈和预防黏膜损伤。作为一类药物，它们极其安全。与奥美拉唑和兰索拉唑相比，最新的PPI埃索美拉唑在糜烂性食管炎患者的黏膜损伤愈合和症状缓解方面有统计学上的显著提高。本文综述了药物治疗在有或无糜烂性食管炎的有症状患者的短期和长期管理中的作用，包括食管外表现、妊娠期GERD和巴雷特食管。难治性患者的管理也在文中进行了探讨。
