最新Gastroesophageal Reflux Disease教学讲义PPT课件.ppt

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1、GastroesophagealRefluxDiseaseObjectivesDefinitionofGERDEpidemiologyofGERDPathophysiologyofGERDClinicalManisfestationsDiagnosticEvaluationTreatmentComplicationsDefinitionAmericanCollegeofGastroenterology(ACG)SymptomsORmucosaldamageproducedbytheabnormalrefluxofgastriccontentsintotheesophagusOftenchro

2、nicandrelapsingMayseecomplicationsofGERDinpatientswholacktypicalsymptomsClinicalManisfestationsMostcommonsymptomsHeartburn—retrosternalburningdiscomfortRegurgitation—effortlessreturnofgastriccontentsintothepharynxwithoutnausea,retching,orabdominalcontractionsClinicalManisfestationsDysphagia—difficu

3、ltyswallowingOthersymptomsinclude:Chestpain,waterbrash,globussensation,odynophagia,nauseaExtraesophagealmanifestationsAsthma,laryngitis,chroniccoughDiagnosticEvaluationIfclassicsymptomsofheartburnandregurgitationexistintheabsenceof“alarmsymptoms”thediagnosisofGERDcanbemadeclinicallyandtreatmentcanb

4、einitiatedAlarmsAlarmSigns/SymptomsDysphagiaEarlysatietyGIbleedingOdynophagiaVomitingWeightlossIrondeficiencyanemiaTrialofMedicationsH2RAorPPIExpectresponsein2-4weeksIfnoresponseChangefromH2RAtoPPIMaximizedoseofPPITrialofMedicationsIfPPIresponseinadequatedespitemaximaldosageConfirmdiagnosisEGD24hou

5、rpHmonitorEsophagogastrodudenoscopyEndoscopy(withbiopsyifneeded)Inpatientswithalarmsigns/symptomsThosewhofailamedicationtrialThosewhorequirelong-termtxLackssensitivityforidentifyingpathologicrefluxAbsenceofendoscopicfeaturesdoesnotexcludeaGERDdiagnosisAllowsfordetection,stratification,andmanagement

6、ofesophagealmanisfestationsorcomplicationsofGERDpH24-hourpHmonitoringAcceptedstandardforestablishingorexcludingpresenceofGERDforthosepatientswhodonothavemucosalchangesTrans-nasalcatheterorawireless,capsuleshapeddevicePatientwithheartburnIniatetxwithH2RAorPPIH2RAtakenBIDGoodresponseFrequentrelapsesO

7、ndemandtxPPItakenQDGoodresponseMaintenancetherapywithlowesteffectivedoseSymptomspersistConsiderEGDifriskfactorspresent(>45,white,maleand>5yrsofsx)IncreasetomaxdoseQDorBIDGoodresponseConfirmdiagnosisEGD,phmo