Freston J W, Malagelada J R, Petersen H, McCloy R F
University of Connecticut Health Center, Farmington, USA.
Eur J Gastroenterol Hepatol. 1995 Jun;7(6):577-86.
To discuss some of the critical issues in the management of gastroesophageal reflux disease (GERD).
GERD is a chronic relapsing disease characterized by pathological exposure of the distal esophagus to gastric acid. Diagnosis of the condition can often be made on the basis of symptomatology alone. Endoscopy can help in assessing the degree of esophageal damage, influencing the choice of therapy, and should be performed at least once during a symptomatic patient's lifetime to exclude a diagnosis of Barrett's esophagus. However, endoscopy is mandatory at diagnosis if alarm symptoms are present. Treatment should aim to provide the lowest degree of acid suppression needed for the control of symptoms. Proton pump inhibitors (PPIs) represent the most cost-effective treatment option for the short- and long-term management of GERD. Compared with standard- and high-dose H2-receptor antagonists, PPIs result in superior and faster healing and symptom relief across all grades of esophagitis and are more effective at maintaining patients in symptomatic and endoscopic remission. Treatment with PPIs has also been shown to reduce the rate of recurrent stricture after initial dilatation. PPIs are generally well tolerated, and to date there have been no reports of gastric dysplasia resulting from their long-term use. Anti-reflux surgery should be reserved for patients who are unresponsive to continuous PPI therapy or perhaps for young patients. It will be several years before the impact of laparoscopic fundoplication as a cost-beneficial therapy for GERD can be assessed.
The superior clinical efficacy of PPIs when compared with any other drug regimen for GERD make them the treatment of choice for the short- and long-term management of this troublesome condition.
探讨胃食管反流病（GERD）管理中的一些关键问题。
GERD是一种慢性复发性疾病，其特征为远端食管病理性暴露于胃酸。该病的诊断通常仅凭症状即可做出。内镜检查有助于评估食管损伤程度，影响治疗方案的选择，并且对于有症状的患者，一生中应至少进行一次内镜检查以排除巴雷特食管的诊断。然而，如果存在警示症状，则在诊断时必须进行内镜检查。治疗应旨在提供控制症状所需的最低程度的抑酸。质子泵抑制剂（PPI）是GERD短期和长期管理中最具成本效益的治疗选择。与标准剂量和高剂量H2受体拮抗剂相比，PPI在所有食管炎分级中均能带来更优且更快的愈合和症状缓解，并且在维持患者症状缓解和内镜缓解方面更有效。PPI治疗还显示可降低初次扩张后复发性狭窄的发生率。PPI一般耐受性良好，迄今为止，尚无因长期使用PPI导致胃发育异常的报道。抗反流手术应仅用于对持续PPI治疗无反应的患者或可能用于年轻患者。腹腔镜胃底折叠术作为GERD的一种成本效益疗法的影响，还需要数年时间才能评估。
与GERD的任何其他药物治疗方案相比，PPI具有卓越的临床疗效，使其成为这种棘手疾病短期和长期管理的首选治疗方法。
