Howden Colin W, Chey William D
Division of Gastroenterology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
J Fam Pract. 2003 Mar;52(3):240-7.
Heartburn on 2 or more days a week warrants medical attention, as patients are likely to suffer from gastroesophageal reflux disease (GERD). Chronic GERD can lead to the development of complications including erosive esophagitis, stricture formation, and Barrett's esophagus, which increases the risk of esophageal adenocarcinoma. A trial with a proton pump inhibitor (PPI) is the quickest and most cost-effective way to diagnose GERD, and is at least as sensitive as 24-hour intra-esophageal pH monitoring. As PPIs only bind to actively secreting proton pumps, they should be dosed 30 to 60 minutes before a meal. Despite these recommendations, a recent survey of over 1000 US primary care physicians found that 36% instructed their patients to take a PPI with or after a meal or did not specify the timing of dosing. The patients who will have the best response to surgical therapy for GERD are those who had clearly documented acid reflux with typical symptoms, and who have responded to PPI treatment. Unfortunately, the same survey found that most physicians recommend antireflux surgery for patients in whom medical therapy has failed.
每周出现两天或以上烧心症状需要就医，因为患者可能患有胃食管反流病（GERD）。慢性GERD会引发包括糜烂性食管炎、狭窄形成和巴雷特食管在内的并发症，这会增加食管腺癌的风险。使用质子泵抑制剂（PPI）进行试验是诊断GERD最快且最具成本效益的方法，其敏感性至少与24小时食管内pH监测相同。由于PPI仅与活跃分泌的质子泵结合，应在饭前30至60分钟给药。尽管有这些建议，但最近一项针对1000多名美国初级保健医生的调查发现，36%的医生指示患者在进餐时或进餐后服用PPI，或者未明确给药时间。对GERD手术治疗反应最佳的患者是那些有明确记录的伴有典型症状的胃酸反流且对PPI治疗有反应的患者。不幸的是，同一项调查发现，大多数医生会为药物治疗失败的患者推荐抗反流手术。
