Hirschowitz B I
Department of Medicine, University of Alabama at Birmingham 35294, USA.
Yale J Biol Med. 1996 May-Jun;69(3):271-81.
Simple intermittent heartburn with minor or no esophagitis can be treated with simple measures including lifestyle changes and antacids as needed, or H2 receptor antagonists (H2RA), and has a good outcome. Problematic reflux includes resistance to therapy, stricture, Barrett's esophagus and aspiration. Severe reflux esophagitis, often resistant to H2RA therapy, requires more potent treatment with potent acid suppression using proton pump inhibitors, often indefinitely. When complicated by stricture, dilatations with potent acid suppression are needed. Barrett's esophagus is subject to esophagitis, which is no more difficult to treat than other cases of esophagitis. Reflux in Barrett's esophagus should be treated on its own merits without regard to the presence of Barrett's epithelium. Dysplasia leading to adenocarcinoma is a different problem, apparently not influenced by reduced exposure to acid. Indications for antireflux surgery are quite limited and should be carefully analyzed as a cost/risk/benefit problem.
伴有轻度食管炎或无食管炎的单纯间歇性烧心，可采用包括改变生活方式和按需使用抗酸剂等简单措施进行治疗，或使用H2受体拮抗剂（H2RA），预后良好。有问题的反流包括治疗抵抗、狭窄、巴雷特食管和误吸。严重的反流性食管炎通常对H2RA治疗耐药，需要使用质子泵抑制剂进行更强效的抑酸治疗，且通常需要长期治疗。当并发狭窄时，需要在强效抑酸的同时进行扩张治疗。巴雷特食管易患食管炎，其治疗并不比其他食管炎病例更困难。巴雷特食管的反流应根据其自身情况进行治疗，而不考虑巴雷特上皮的存在。导致腺癌的发育异常是另一个问题，显然不受酸暴露减少的影响。抗反流手术的适应证相当有限，应作为成本/风险/效益问题进行仔细分析。
