胃食管反流病诊断与治疗指南

Gastroesophageal refl ux disease (GERD) is arguably the most common disease encountered by the gastroenterologist. It is equally likely that the primary care providers will fi nd that complaints related to refl ux disease constitute a large proportion of their practice. Th e following guideline will provide an overview of GERD and its presentation, and recommendations for the approach to diagnosis and management of this common and important disease.

The document will review the presentations of any risk factors for GERD, the diagnostic modalities and their recommendation for use and recommendations for medical, surgical and endoscopic management including comparative eff ectiveness of diff erent treatments. Extraesophageal symptoms and complications will be addressed as will the evaluation and management of “ refractory ” GERD. Th e document will conclude with the potential risks and side eff ects of the main treatments for GERD and their implications for patient management.

Each section of the document will present the key recommendations related to the section topic and a subsequent summary of the evidence supporting those recommendations. An overall summary of the key recommendations is presented in Table 1 .

A search of OVID Medline, Pubmed and ISI Web of Science was conducted for the years from 1960 – 2011 using the following major search terms and subheadings including “ heartburn ” , “ acid regurgitation ” , “ GERD ” , “ lifestyle interventions ” , “ proton pump inhibitor (PPI)” , “ endoscopic surgery, ” “ extraesophageal symptoms, ” “ Nissen fundoplication, ” and “ GERD complications. ” We used systematic reviews and meta-analyses for each topic when available followed by a review of clinical trials.

The GRADE system was used to evaluate the strength of the recommendations and the overall level of evidence ( 1,2 ). Th e level of evidence could range from “ high ” (implying that further research was unlikely to change the authors ’ confi dence in the estimate of the eff ect) to “ moderate ” (further research would be likely to have an impact on the confi dence in the estimate of eff ect) or “ low” (further research would be expected to have an important impact on the confi dence in the estimate of the eff ect and would be likely to change the estimate). Th e strength of a recommendation was graded as “ strong ” when the desirable eff ects of an intervention clearly outweigh the undesirable eff ects and as “ conditional ” when there is uncertainty about the trade-off s.

It is important to be aware that GERD is defi ned by consensus and as such is a disease comprising symptoms, end-organ eff ects and complications related to the refl ux of gastric contents into the esophagus, oral cavity, and / or the lung. Taking into account the multiple consensus defi nitions previously published ( 3 – 5 ), the authors have used the following working defi nition to define the disease: GERD should be defi ned as symptoms or complications resulting from the refl ux of gastric contents into the esophagus or beyond, into the oral cavity (including larynx) or lung. GERD can be further classifi ed as the presence of symptoms without erosions on endoscopic examination (nonerosive disease or NERD) or GERD symptoms with erosions present (ERD).

全文地址：