Marshall J B
Department of Medicine, University of Missouri-Columbia School of Medicine 65212.
Postgrad Med. 1989 May 15;85(7):92-100. doi: 10.1080/00325481.1989.11700722.
Symptomatic gastroesophageal reflux is one of the most common complaints encountered by clinicians. The pathogenesis of reflux remains unclear, but multiple factors are involved. Heartburn is the most common clinical manifestation. The history and barium esophagram provide sufficient diagnostic information in most cases. Other studies, including ambulatory pH monitoring, the Bernstein test, endoscopy with biopsy, and esophageal manometry, are warranted if the patient has atypical symptoms, an incomplete response to therapy, dysphagia, or abnormalities on the esophagram. Proper utilization of these studies requires an understanding of the questions each test answers. Reflux disease is often a chronic problem. Many patients can be treated symptomatically by a combination of life-style modifications and use of antacids. Patients who do not respond adequately to these simple measures or who have documented erosive esophagitis usually require further drug therapy.
症状性胃食管反流是临床医生最常遇到的主诉之一。反流的发病机制尚不清楚，但涉及多种因素。烧心是最常见的临床表现。在大多数情况下，病史和食管钡餐造影可提供足够的诊断信息。如果患者有非典型症状、对治疗反应不完全、吞咽困难或食管钡餐造影异常，则需要进行其他检查，包括动态pH监测、伯恩斯坦试验、内镜检查及活检和食管测压。正确使用这些检查需要了解每项检查所能回答的问题。反流性疾病通常是一个慢性问题。许多患者可通过改变生活方式和使用抗酸剂进行对症治疗。对这些简单措施反应不佳或有记录的糜烂性食管炎患者通常需要进一步的药物治疗。
