GERD (Gastroesophageal reflux disease, GERD) refers to anti-gastric contents into the esophagus causing symptoms and (or) complications of a disease. According to statistics, 10-20% in Western countries have gastroesophageal reflux symptoms, GERD accounted for 14-17% of them, our prevalence is lower than in Western countries, and less severe. The incidence of GERD increases with age to 40-60 years as the peak incidence between men and women roughly the same.
Gastroesophageal reflux disease can be divided into three types
1, non-erosive reflux disease (NERD): there is reflux-related symptoms, but no endoscopic Barrett esophagus and esophageal mucosal damage;
2, erosive esophagitis (EE): endoscopic mucosal damage seen in the distal esophagus;
3, Barrett's esophagus (BE): The complex layer of esophageal squamous metaplasia of the epithelium is replaced by a pathological phenomenon, with or without IM, intestinal metaplasia. One associated with a specific intestinal metaplasia are precancerous lesion of esophageal adenocarcinoma.
Circumstances prone to gastroesophageal reflux disease?
◆ age, gender :40-60-year-old gastroesophageal reflux disease are more likely to occur, including reflux esophagitis (RE) more than the male, male to female ratio of about 2 to 3:1;
◆ Smoking, eating too much salt: a report of Sweden, smoking and excessive intake of salt may occur gastroesophageal reflux (GERD) symptoms, risk factors, dietary fiber and physical activity is protective against reflux effect.
◆ body mass index (BMI = weight kg divided by the square of height m, the normal weight BMI index = 18 ~ 25) increase: the Norwegian scientists have published a study that compared with lean individuals with physical compared to obese, especially women, acid reflux, chronic significantly increased risk.
◆ Excessive drinking: alcohol on the stomach, esophagus continued to stimulate increased risk of suffering from gastroesophageal reflux disease.
◆ aspirin, nonsteroidal anti-inflammatory drugs, anti-cholinergic drugs.
◆ manual: in particular, heavy physical labor.
◆ social factors, psychosomatic disease and family history.
Knowledge base of reflux symptoms - symptoms associated with reflux
1, typical and common symptoms: heartburn and regurgitation. Heartburn, retrosternal feeling that there is self-burning, anti-influenza, that is, they have the stomach contents of patients to the direction of movement of the throat or mouth feel.
2, no typical symptoms: upper abdominal pain, chest pain, belching, bloating, abdominal discomfort, foreign body sensation in the throat, swallowing pain, difficulty swallowing
3, esophageal symptoms: chronic cough, reflux, laryngitis, asthma, tooth decay and other related syndrome confirmed with gastroesophageal reflux disease, and pharyngitis, sinusitis, idiopathic pulmonary fibrosis, recurrent otitis media is gastroesophageal reflux disease may be related.
Listed above reflux-related symptoms, if not negative impact on patient quality of life, not as a basis for the diagnosis of GERD.
How do I know if suffering from gastroesophageal reflux disease?
1, see symptoms
(1) typical symptoms of heartburn and regurgitation, clinically considered a gastroesophageal reflux disease;
(2) esophageal symptoms (reflux related cough, asthma, laryngitis, tooth decay, etc.) there reflux symptoms could be considered anti-flow-related or may be related to esophageal symptoms;
(3) endoscopy has been widely carried out in China, on patients attending general be carried out before endoscopy is feasible to shorten the diagnosis time.
(4) is not a function of burning them?
Functional heartburn patients have heartburn symptoms, but the lack of reflux is causing the symptoms of the evidence that endoscopy without esophageal mucosal injury, 24-hour pH testing real acid reflux negative symptom index and the PPI experimental treatment negative (but positive results can not exclude functional heartburn).
2, so check
(1) diagnostic test (PPI)
The proton pump inhibitor (PPI) diagnostic treatment method has proven to be effective, concrete method is: optional omeprazole, lansoprazole and other drugs, a standard dose of PPI, 2 times / d, treatment 1 to 2 weeks, if symptoms improved after medication, the support of gastroesophageal reflux disease; such as symptom improvement after taking the obvious, there may be factors other than acid reflux disease, or does not support.
(2), gastroscopy
Gastroscopy and histopathology diagnosis of EE, and Barrett's esophagus gold standard.
(3) pathological
Starting from the gastroesophageal junction biopsy drawn up for the conventional materials should take 2cm intervals, on the inter-change or suspected cancer of the BE should be drawn to 1 cm intervals should be at four quadrant biopsy, ulcer, erosion, plaques, nodules and other cavity narrow exceptions, have to biopsy.
(4) 24-hour esophageal pH monitoring
24-hour esophageal pH monitoring is the diagnosis of gastroesophageal reflux has the best qualitative and quantitative examination method, pH <4 for determining the existence of the limits of counter-flow point, pH <4 time called reflux, is a clinical application The most extensive anti-flow variables. The examination method in the diagnosis of erosive esophagitis positive rate> 80%, NERD patients was 50% to 75%. Among them, the wireless esophageal pH monitoring can provide more long acid reflux test, get a higher positive rate.
Schematic diagram of 24-hour esophageal pH monitoring
(5) Other inspections
Such as X ray and radionuclide, reflux monitoring, esophageal acid irrigation checks, new endoscopic technologies such as chromoendoscopy, magnifying endoscopy, light-induced fluorescence endoscopy and light scattering spectroscopic techniques and so on.
After the diagnosis of gastroesophageal reflux disease how to do?
Treatment goals: heal esophagitis, relieve symptoms and improve quality of life and prevent complications.
Treatment:
1, changes in lifestyle
Raise the bed, not eating 3 hours before bedtime; avoid high-fat foods; quit tobacco and alcohol, diet.
2, drug therapy
Drugs inhibiting gastric acid secretion - is the basic method of treatment of gastroesophageal reflux disease: inhibition of gastric acid drugs, including H2-receptor antagonist (H2RA) and PPI, etc. The goal of treatment, 18 hours pH> 4. Including increased acid suppression and strong acid-suppressing two strategies, the former slow onset, long course and often require repeated and repeated endoscopic treatment, while the latter rapid onset, short duration, can reduce the number and attendance endoscopy times.
Prokinetic drug therapy - can be used as adjuvant treatment for acid suppression drugs, such as domperidone (Motilium) and so on.
Mucous membrane of medicine - no status
Psychological treatment and antidepressants - can be used in patients with NERD
3, surgical treatment
Surgery in relieving symptoms and healing of esophagitis and the role of drug therapy rather, complications and mortality and surgeon experience and skill levels are closely related, a considerable proportion of patients (11% -60%) was still drug addition, surgery can not reduce the risk of esophageal adenocarcinoma. The need for surgery, should be combined with the wishes of patients and surgeons Decisions are made.
4, endoscopic therapy
Endoscopic treatment of gastroesophageal reflux disease symptom score can be improved, improve patient satisfaction and quality of life and reduce the amount of PPI; but endoscopic treatment does not solve many problems, including: long-term efficacy, patient acceptability and security, ease symptoms of gastroesophageal reflux disease is effective and so is not typical, and, occasionally endoscopic treatment of serious complications such as perforation and death, but rare, well-trained doctors are careful endoscopic conduct of endoscopic treatment.
Ray's Stretta radiofrequency therapy: Ray's Stretta treatment instrument through the tiny probe will be sent to radio frequency energy and gastric cardia lower esophageal sphincter muscles of the upper layer, so that they have some muscle contraction. The contraction in seven days after the formation of life-long change.
Endoscopic surgery: for the patients with dysplasia and mucosal carcinoma in BE patients, and endoscopic ultrasonography excluded the lymph node metastasis.
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