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[食管疾病:胃食管反流病、巴雷特食管病、贲门失弛缓症和嗜酸性粒细胞性食管炎]

[Oesophageal diseases: gastroesophageal reflux disease, Barrett's disease, achalasia and eosinophilic oesophagitis].

作者信息

Calvet Xavier

机构信息

Servicio de Aparato Digestivo, Hospital de Sabadell, Institut Universitari Parc Taulí, Sabadell, Barcelona, España; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; CIBERehd, Instituto de Salud Carlos III, España.

出版信息

Gastroenterol Hepatol. 2015 Sep;38 Suppl 1:49-55. doi: 10.1016/S0210-5705(15)30019-4.

Abstract

The most important novel findings presented on oesophageal disease in DDW 2015 were the following: 1) GERD: a) hypervigilance seems to be a key pathogenic factor in reflux symptoms refractory to PPI; b) post-reflux swallowing-induced peristaltic waves could be an excellent diagnostic criterion for GERD; c) laryngeal pH-metry is not useful in the diagnosis of extra-oesophageal symptoms; d) the recommendation of weight loss adequately recorded in the clinical reports of patients with GERD and obesity or overweight is an excellent quality indicator and is associated with better outcomes. 2) Barrett's oesophagus: a) persistent low-grade dysplasia in more than one endoscopy and a diagnosis of "indefinite for dysplasia" are associated with a high risk of neoplastic progression; b) narrow-band imaging allows areas of dysplasia on Barrett's oesophagus to be identified with high sensitivity and specificity; c) initial endoscopy fails to identify a high percentage of advanced neoplasms in Barrett's oesophagus. Early re-endoscopy should be considered; d) endoscopists specialized in Barret's oesophagus obtain a much higher yield in the diagnosis of advanced lesions. Patients at high risk-men, older patients, smokers and those with long-segment Barrett's oesophagus-could benefit from follow-up in a referral center. 3) Achalasia: POEM seems safe and effective, independently from patient characteristics (age, comorbidity) and the technical variations used. 4) Eosinophilic esophagitis: topical budesonide and exclusion diets are reasonably effective in PPI non-responders.

摘要

2015年消化疾病周(DDW)上展示的关于食管疾病的最重要的新发现如下:1)胃食管反流病(GERD):a)过度警觉似乎是对质子泵抑制剂(PPI)难治的反流症状的关键致病因素;b)反流后吞咽诱发的蠕动波可能是GERD的一项出色诊断标准;c)喉pH测定法对诊断食管外症状无用;d)在GERD与肥胖或超重患者的临床报告中充分记录的减肥建议是一项出色的质量指标,且与更好的预后相关。2)巴雷特食管:a)在不止一次内镜检查中持续存在低度异型增生以及诊断为“异型增生不明确”与肿瘤进展的高风险相关;b)窄带成像能够以高灵敏度和特异性识别巴雷特食管上的异型增生区域;c)初次内镜检查未能识别出巴雷特食管中高比例的晚期肿瘤。应考虑早期再次内镜检查;d)专门从事巴雷特食管诊治的内镜医师在诊断晚期病变方面的检出率要高得多。高危患者——男性、老年患者、吸烟者以及患有长段巴雷特食管的患者——可从转诊中心的随访中获益。3)贲门失弛缓症:经口内镜下肌切开术(POEM)似乎安全有效,与患者特征(年龄、合并症)及所采用的技术差异无关。4)嗜酸性食管炎:局部用布地奈德和排除饮食疗法对PPI无反应者相当有效。

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