Berquist W E
Pediatr Ann. 1982 Jan;11(1):135-42. doi: 10.3928/0090-4481-19820101-09.
The diagnosis of gastroesophageal reflux requires careful consideration of the patient's clinical history and initial evaluation of presenting symptoms. In cases where overt vomiting in noted, the initial evaluation should include a barium esophagram and upper gastrointestinal series. The diagnosis of gastroesophageal reflux may not be established by one test alone, but may require many tests to confirm the presence of significant reflux and to assess its sequellae. It is imperative to demonstrate that the extent and timing of GER is not merely physiologic. Continuous intraesophageal pH monitoring has proven to be the most sensitive test for gastroesophageal reflux and better identifies its frequency, duration, and relationship to other symptoms. Manometry assesses the competence of the lower esophageal sphincter and integrity of esophageal peristalsis. The standard acid reflux test is a provocative test of gastroesophageal reflux. Gastric outlet obstruction, both organic and functional, may be primary causes of gastroesophageal reflux, and may be evaluated with barium contrast studies and scintigraphic stomach-emptying studies. Poor esophageal transit and clearance are contributing factors which promote esophagitis. Treatment of gastroesophageal reflux requires identification of the primary cause, and selection of the therapeutic modality appropriate to the severity of reflux and its associated sequellae. In those patients with severe clinical sequellae, the most effective treatment for gastroesophageal reflux is surgical fundoplication.
胃食管反流的诊断需要仔细考虑患者的临床病史并对出现的症状进行初步评估。在出现明显呕吐的病例中，初步评估应包括食管钡餐造影和上消化道造影。胃食管反流的诊断不能仅通过一项检查来确立，可能需要多项检查来确认显著反流的存在并评估其后果。必须证明胃食管反流的程度和时间不仅仅是生理性的。持续食管pH监测已被证明是检测胃食管反流最敏感的方法，能更好地确定其频率、持续时间以及与其他症状的关系。食管测压可评估食管下括约肌的功能以及食管蠕动的完整性。标准酸反流试验是一种诱发胃食管反流的试验。胃出口梗阻，无论是器质性还是功能性的，都可能是胃食管反流的主要原因，可通过钡剂造影研究和闪烁扫描胃排空研究进行评估。食管转运和清除功能不佳是促进食管炎发生的因素。胃食管反流的治疗需要确定主要病因，并根据反流的严重程度及其相关后果选择合适的治疗方式。对于那些有严重临床后果的患者，治疗胃食管反流最有效的方法是手术胃底折叠术。
