The Neuroenteric Clinical Research Group, Southern Arizona VA Health Care System, University of Arizona, Tucson, Arizona 85723-0001, USA.
J Gastroenterol Hepatol. 2012 Apr;27 Suppl 3:3-7. doi: 10.1111/j.1440-1746.2012.07064.x.
Refractory gastroesophageal reflux disease may affect up to one-third of the patients that consume proton pump inhibitor (PPI) once daily. Treatment in clinical practice has been primarily focused on doubling the PPI dose, despite lack of evidence of its value. In patients who failed PPI twice daily, medical treatment has been primarily focused on reducing transient lower esophageal sphincter relaxation rate or attenuating esophageal pain perception using visceral analgesics. In patients with evidence of reflux as the direct trigger of their symptoms, endoscopic treatment or antireflux surgery may be helpful in remitting symptoms. The role of psychological interventions, as well as non-traditional therapeutic strategies remains to be further elucidated.
难治性胃食管反流病可能影响多达三分之一每日服用质子泵抑制剂 (PPI) 的患者。尽管缺乏其价值的证据，但临床实践中的治疗主要集中在将 PPI 剂量加倍。对于每日两次服用 PPI 失败的患者，主要通过降低短暂性食管下括约肌松弛率或使用内脏镇痛药来减轻食管疼痛感觉来进行药物治疗。对于有反流作为其症状直接诱因的患者，内镜治疗或抗反流手术可能有助于缓解症状。心理干预以及非传统治疗策略的作用仍有待进一步阐明。
