McGuigan J E, Belafsky P C, Fromer L, McCarthy D, Nostrant T, Postma G N, Welage L S, Wolfe M M
Division of Gastroenterology, University of Florida College of Medicine, Gainesville, FL 32610, USA.
Aliment Pharmacol Ther. 2004 Dec;20 Suppl 9:57-72. doi: 10.1111/j.1365-2036.2004.02241.x.
Symptoms of gastro-oesophageal reflux disease (GERD) range from mild to severe and, when they occur during night-time hours, can interfere with sleep patterns and reduce overall quality of life. The clinical presentation of GERD is characterized by oesophageal as well as supra-oesophageal symptoms, including otolaryngologic and pulmonary complications. However, GERD may be overlooked as the cause of a patient's supra-oesophageal symptoms because these complaints can occur in the absence of oesophageal symptoms or endoscopic changes. The role of available tools used for GERD diagnosis, including endoscopy, oesophageal pH monitoring and an empirical course of proton pump inhibitor therapy, is discussed. Interventions available to achieve the therapeutic goals of symptom relief and prevention include specific lifestyle modifications and over-the-counter as well as prescription pharmacological agents. Patient-initiated, as-needed treatment may not be the best choice for managing persistent night-time reflux because it requires patient arousal from sleep. Proton pump inhibitor therapy remains the treatment of choice for patients with more severe symptoms and those with erosive oesophagitis. Few studies have specifically evaluated the role of pharmacological agents in the management of night-time reflux and comparisons are difficult due to the variability in study design and endpoints assessed.
胃食管反流病（GERD）的症状从轻到重不等，当这些症状在夜间出现时，会干扰睡眠模式并降低整体生活质量。GERD的临床表现以食管症状以及食管上症状为特征，包括耳鼻喉科和肺部并发症。然而，GERD可能会被忽视，因为这些症状可能在没有食管症状或内镜改变的情况下出现。本文讨论了用于GERD诊断的现有工具的作用，包括内镜检查、食管pH监测和质子泵抑制剂治疗的经验性疗程。为实现缓解症状和预防的治疗目标而采取的干预措施包括特定的生活方式改变以及非处方和处方药物。患者自行按需治疗可能不是管理持续性夜间反流的最佳选择，因为这需要患者从睡眠中醒来。质子泵抑制剂治疗仍然是症状较重患者和糜烂性食管炎患者的首选治疗方法。很少有研究专门评估药物在夜间反流管理中的作用，由于研究设计和评估终点的变异性，很难进行比较。
