亚洲非糜烂性反流病的治疗策略
Strategy for treatment of nonerosive reflux disease in Asia.
作者信息
Hiyama Toru, Yoshihara Masaharu, Tanaka Shinji, Haruma Ken, Chayama Kazuaki
机构信息
Health Service Center, Hiroshima University, 1-7-1 Kagamiyama, Higashihiroshima 739-8521, Japan.
出版信息
World J Gastroenterol. 2008 May 28;14(20):3123-8. doi: 10.3748/wjg.14.3123.
Abstract
The paper is to review the clinical and pathophysiologic differences between of nonerosive reflux disease (NERD) and reflux esophagitis (RE), and to propose a treatment strategy for NERD, especially for patients in Asia. A Medline search was performed regarding the clinical and pathophysiologic differences between NERD and RE, and treatment of NERD and RE. The characteristics of NERD patients in Asia are as follows: (1) high proportion of female patients, (2) low frequency of hiatal hernia, (3) high frequency of H pylori infection, (4) severe glandular atrophy of the gastric mucosa, and (5) frequent resistance to proton pump inhibitor (PPI) therapy. In Asian NERD patients, exposure of the esophagus to acid is not increased, and esophageal motility is normal. These characteristics are similar to those of patients in Western countries. Our recommended first-choice treatment is administration of PPI in combination with a prokinetic agent. However, at present, because there is limited evidence regarding effective treatments for NERD, it is best to try several different treatment strategies to find the best treatment for each patient.
摘要
本文旨在综述非糜烂性反流病（NERD）与反流性食管炎（RE）之间的临床及病理生理差异，并提出针对NERD的治疗策略，尤其是针对亚洲患者。我们对Medline进行了检索，内容涉及NERD与RE之间的临床及病理生理差异，以及NERD和RE的治疗。亚洲NERD患者的特征如下：（1）女性患者比例高；（2）食管裂孔疝发生率低；（3）幽门螺杆菌感染率高；（4）胃黏膜腺体萎缩严重；（5）对质子泵抑制剂（PPI）治疗耐药频繁。在亚洲NERD患者中，食管酸暴露未增加，食管动力正常。这些特征与西方国家患者相似。我们推荐的首选治疗方法是PPI联合促动力剂。然而，目前由于关于NERD有效治疗的证据有限，最好尝试几种不同的治疗策略，为每位患者找到最佳治疗方法。
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