Beck I T
Gastrointestinal Disease Research Unit, Queen's University, Kingston, Ontario.
Can J Gastroenterol. 1997 Sep;11 Suppl B:21B-27B.
This article reviews the major changes that have occurred since the last Canadian consensus conference on gastroesophageal reflux disease (GERD), which was held four years ago. There were developments in the understanding of the pathophysiology of this disease and improvements in the methods of its investigation and management. Esophageal and extraesophageal complications have also been better defined. Since 1992 new knowledge on nitric oxide has been gained and several new inflammatory cytokines have been developed. Improved understanding of the mechanism of the hypersensitive esophagus helped to explain the presence of clinical symptoms with normal endoscopic findings. This also improved interpretation of the role of 24 h pH monitoring and 24 h pH with motility recording. There is better understanding of the role of H2 receptor antagonists and prokinetics and an increasing confidence in the long term safety of proton pump inhibitors (PPIs). The most important changes occurred in surgery with the introduction of laparoscopic fundoplication. Patients with Barrett's esophagus who are too ill for esophagectomy may now be enrolled in surveillance because it is possible to deal with dysplasia and small cancers with photodynamic therapy. As an introductory lecture to the consensus conference, this article also deals with the subject of health economics and discusses the necessity and the dangers involved in devising treatment guidelines. It indicates that guidelines change with advancing knowledge, and emphasizes that physicians' primary duty is toward their patients. Therefore, guidelines devised here should be adjusted to the individual needs of patients. Organizational aspects of the present conference are also described.
本文回顾了自四年前召开的上一次加拿大胃食管反流病（GERD）共识会议以来所发生的主要变化。在对该疾病病理生理学的认识、研究方法及治疗手段方面均有进展。食管及食管外并发症也得到了更明确的界定。自1992年以来，人们获得了关于一氧化氮的新知识，并且研发出了几种新的炎性细胞因子。对高敏食管机制的深入理解有助于解释在内镜检查结果正常的情况下出现临床症状的原因。这也改进了对24小时pH监测以及24小时pH与动力记录作用的解读。对H2受体拮抗剂和促动力药的作用有了更好的理解，并且对质子泵抑制剂（PPI）的长期安全性越来越有信心。随着腹腔镜胃底折叠术的引入，手术方面发生了最重要的变化。因病情过重而无法进行食管切除术的巴雷特食管患者现在可以纳入监测，因为可以通过光动力疗法处理发育异常和小癌灶。作为共识会议的 introductory lecture（此处原文有误，可能是introductory lecture，应译为“ introductory lecture”为“ introductory lecture”，“ introductory lecture”为“ introductory lecture”，“ introductory lecture”为“ introductory lecture”，“ introductory lecture”为“ introductory lecture”，“ introductory lecture”为“ introductory lecture”，“ introductory lecture”为“ introductory lecture”，“ introductory lecture”为“ introductory lecture”，“ introductory lecture”为“ introductory lecture”，“ introductory lecture”为“ introductory lecture”，“ introductory lecture”为“ introductory lecture”，“ introductory lecture”为“ introductory lecture”，“ introductory lecture”为“ introductory lecture”，“ introductory 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