Armstrong D
Division of Gastroenterology, McMaster University, Hamilton, ON, Canada.
Aliment Pharmacol Ther. 2008 Oct 1;28(7):841-53. doi: 10.1111/j.1365-2036.2008.03804.x. Epub 2008 Jul 12.
Management strategies for gastro-oesophageal reflux disease (GERD) are often inconsistent with the proposition that it is a persistent or chronic disease.
To determine the persistence of reflux symptoms and complications associated with GERD.
Systematic searches of Medline and EMBASE.
In longitudinal studies, 65% (95% CI 54-75%) of patients with complicated GERD and 70% (95% CI 57-83%) of patients with 'defined' GERD had persistent disease at follow-up, whereas 34% (95% CI 27-40%) with infrequent or mild reflux symptoms at baseline had persistent symptoms. Clinical trials of maintenance treatment for at least 6 months after healing of oesophagitis reported mean relapse rates of 75% (95% CI 68-82%) in patients taking placebo and 28% (95% CI 21-35%) in those taking proton pump inhibitors. Retrospective studies reported that 34-41% of individuals with GERD recalled experiencing their symptoms for >10 years. The prevalence of GERD is high (10-20%), whereas the incidence is low (4.5-19.6 cases per 1000 person-years), suggesting that GERD is likely to persist for at least 18 years.
Individuals with GERD have persistent reflux symptoms that merit management as a chronic disease; infrequent reflux symptoms are less likely to be chronic and may respond to different management strategies.
胃食管反流病（GERD）的管理策略往往与它是一种持续性或慢性疾病的观点不一致。
确定与GERD相关的反流症状和并发症的持续性。
对Medline和EMBASE进行系统检索。
在纵向研究中，复杂GERD患者中有65%（95%可信区间54 - 75%）、“明确”GERD患者中有70%（95%可信区间57 - 83%）在随访时有持续性疾病，而基线时反流症状不频繁或轻微的患者中有34%（95%可信区间27 - 40%）有持续性症状。食管炎愈合后至少6个月维持治疗的临床试验报告，服用安慰剂的患者平均复发率为75%（95%可信区间68 - 82%），服用质子泵抑制剂的患者为28%（95%可信区间21 - 35%）。回顾性研究报告称，34 - 41%的GERD患者回忆其症状出现超过10年。GERD的患病率很高（10 - 20%），而发病率很低（每1000人年4.5 - 19.6例），这表明GERD可能至少持续18年。
GERD患者有持续性反流症状，应作为慢性病进行管理；不频繁的反流症状不太可能是慢性的，可能对不同的管理策略有反应。
