Gastric esophageal reflux disease (GerD) is a common disease in the digestive department. Its prevalence and complex clinical manifestations have a serious impact on the quality of life of patients. And the chronic inflammation of the esophagus has the risk of causing esophageal cancer. How to correctly diagnose and standardize treatment is the focus of clinical work.
02 GERD's clinical manifestations
GERD can be divided into non -eroded reflux (NERD), reflux esophagitis (RE) and Barreta esophageal (BE) according to endoscopy.
NERD: Barrett esophagus and clear esophageal mucosa are damaged in the definition of Gerd but the endoscopy is damaged.
Re: Endoscopy can see the stomach-esophageal mucosa that is connected to the esophagus or above. The mucous membrane is damaged intermittently.
BE: The gastric-esophageal squamous epithelial part of the esophagus-like epithelium of the esophagus connection at the endoscopy is replaced by cylindrical epithelium.
02 GERD's clinical manifestations
In addition to burning heart and reflux, symptoms such as chest pain, upper abdominal pain, and miraculous esophagus, cough, asthma and other esophageal symptoms may occur.
It should be noted that patients with elderly GerD patients have a low incidence of heart and reflux. The incidence of symptoms in extractive tube is high. Symptoms are not typical, or even asymptomatic. The severity of the symptoms is not parallel to the severity of the disease. Factory Guiyu was flat, and when he was a doctor, he was developed in Guangli.
03 GERD's diagnosis
Figure. Typical GerD symptoms and atypical upper digestive tract symptoms suffer from GERD diagnostic flowchart Source: Chinese Medical Association
Diagnostic test of acid suppression agent
For suspicious gerd patients (commonly used PPI), the standard dosage will last for 2 weeks (those with symptoms outside the tube need to last ≥4 weeks). If the symptoms are completely relieved or only one mild symptoms are proved to be effective.
2) Endoscopic
-Re -Los Angeles is divided into grades (see the figure below):
Class A: 1 or more esophageal mucosal damage, the damage length ≤5 mm;
Grade B: 1 or more esophageal mucosal damage, damage length> 5 mm, mucous membrane damage and no fusion;
Class C: At least 2 esophageal mucosa is damaged, and the mucous membrane is damaged blended with each other.
Class D: Refers to the mucosa damage and integration of each other, and the fusion range is 75%of the esophagus.
-BE biopsy strategy: It is recommended that there are multiple and short interval biopsy, and the biopsy is obtained by 1cm interval around the stove. The size of the range is related to the risk of cancer, and the risk of cancer is increasing and increasing the range of 3cm.
3)High -resolution esophageal measurement
Patients with GerD often manifests as ineffective esophageal power: the proportion of 70%or peristalsis failure ratio of 70%or peristalsis is ≥50%.
Anti -current monitoring
It is the standard for diagnosis of CEDD. It is the gold standard of the diagnosis of GERD, including the monitoring of the esophagus NH value and esophageal yang anti -NH value monitoring of the esophagus pipe NH value and esophageal yang anti -NH value monitoring. The percentage of the pH <4 (acid exposure time, AET)> 4%in 24H, it is considered that there is a pathological acid reflux.
04 GERD treatment
Figure .Gerd's treatment flowchart
Source: Chinese Medical Association
Precautions:
-PPI and P-CAB are the first choice for the initial treatment and maintenance of patients with Gard. The initial treatment of the PPI treatment is 8 weeks and the P-CAB treatment is ≥4 weeks.
-For patients with breakthroughs at night (when taking PPI, the pH <4 time> 1H in the night of the night), you can use H2 receptor blockers before going to bed on the basis of PPI treatment, or switch to P-CAB and long. Half -life PPI treatment.
-The anti -acid agent and gastrointestinal active drugs can be used for short -term application to quickly alleviate the symptoms of discomfort such as heart burning and reflux.
-The endoscopic treatment indication: GERD diagnosis is clear, acidic treatment is invalid, unwilling to take medication for a long time, or adverse reactions related to drugs, and cannot tolerate.
-Surgical surgical treatment indicator: there are typical GerD symptoms, PPI treatment is invalid; endoscopy finds the esophageal hernia, BE, RE, Los Angeles grades or above; X -ray examination found that there are esophageal hole hernia.
Post time: Mar-21-2024