Hart J J
Department of Family and Community Medicine, University of Kansas School of Medicine, Wichita 67214, USA.
Am Fam Physician. 1996 Dec;54(8):2463-72.
Gastroesophageal reflux occurs in up to 65 percent of healthy infants. The initial differentiation of physiologic reflux with harmless spitting up from pathologic reflux is often difficult to achieve. Gastroesophageal reflux is caused by transient and intermittent lower esophageal sphincter relaxations unrelated to swallowing. Many tests are available for the diagnosis of gastroesophageal reflux, each with specific indications and limitations. Although no one test is always best, 24-hour esophageal pH monitoring remains the "gold standard" for diagnosis. Its major limitations are its inability to detect reflux for up to two hours following feedings because of the neutralizing effect of the feeding, the lack of correlation with clinical gastroesophageal reflux severity, the expense and the invasive nature of the test. Treatment is determined by the specific presentation. Management of physiologic reflux consists of parental reassurance and counseling about feeding and positioning techniques. Approaches to the management of pathologic reflux range from the use of histamine H2-receptor blockers and prokinetic medications to surgery in severe cases.
高达65%的健康婴儿会发生胃食管反流。区分生理性反流（无害的吐奶）和病理性反流往往很难做到。胃食管反流是由与吞咽无关的一过性、间歇性食管下括约肌松弛引起的。有多种检查可用于诊断胃食管反流，每种检查都有特定的适应证和局限性。虽然没有一种检查总是最佳的，但24小时食管pH监测仍是诊断的“金标准”。其主要局限性在于，由于进食的中和作用，它无法在进食后长达两小时内检测到反流，与临床胃食管反流严重程度缺乏相关性，费用较高，且该检查具有侵入性。治疗取决于具体表现。生理性反流的处理包括让家长放心，并就喂养和体位技巧提供咨询。病理性反流的处理方法从使用组胺H2受体阻滞剂和促动力药物到严重病例的手术治疗不等。
