关注胃食管反流病

汪忠镐院士以误诊亲历呼吁临床重视被誉为中国血管外科首席专家的中国科学院院士、国际血管联盟副主席汪忠镐教授，一年多来常被咳嗽、喘息所困扰，被数位呼吸科医生误诊为支气管哮喘，屡治无效。汪老从自身病症入手，考虑为胃食管反流病，经过相关检查确诊，又经过药物和手术治疗而愈。如同没有一辈子不打败仗的将军一样，也没有一辈子不误诊的神医，即便医生自己生病也难以完全避免误诊，汪老的经历正说明了这点。作为一个富有责任感的医学家，汪老没有满足自己病症的好转，他想临床上会有多少与自己类似的病人也遭遇过误诊误治啊!于是结…     

胃食管反流病引起"顽固性哮喘"以致气胸一例报告

本刊2006年第5期及中国康网相继刊登了中国科学院院士汪忠镐教授以自己切身的误诊经历撰写的“胃食管反流病不容忽视”一文及“关注胃食管反流病”专题后，引起众多媒体关注，CCTV“走进科学”和“健康之路”节目、《健康报》、《中国青年报》、人民网等多家媒体先后给予报道，众多患者登录中国康网咨询该病的诊断及治疗情况。在二炮总医院胃食管反流病中心，证忠镐院士带领工作人员应用新型的Strettac超声射频治疗，为70余位长期误诊的胃食管反流病病人解除了痛苦，并有大量病人预约诊治。新近，汪老给本刊投来一份典型的误诊病例报告，病人患“顽固性哮喘”20年，以致引起气胸，汪老根据亲身误诊经历全面分析病情，考虑胃食管反流病，立即纠误挽治，收效显著。为提高临床医生对胃食管反流病的认知水平，有关汪院士及胃食管反流病中心的工作动态，本刊将继续关注。[编者按]     

胃食管反流病12例误诊心绞痛临床分析

目的总结胃食管反流病误诊为心绞痛的原因及鉴别诊断要点。方法回顾性分析2015年2月-2019年6月在我院被误诊为心绞痛的胃食管反流病12例的临床资料。结果本组均以发作性胸痛为首发症状,经心电图、超声心动图等检查首诊为心绞痛,予相关治疗无效后,行胃镜检查确诊为胃食管反流病。首次就诊至确诊时间5~40 d。12例确诊后予兰索拉唑肠溶片+伊托必利分散片+铝镁二甲硅油咀嚼片治疗8周,治愈8例,显效及有效各2例。结论部分胃食管反流病与心绞痛临床症状相似,极易误诊。临床医师需掌握二者临床特点,开拓诊断思维,熟悉鉴别诊断要点,以提高诊断准确率。     

胃食管反流病误诊32例分析

目的探讨胃食管反流病误诊的原因及减少误诊的方法。方法分析32例误诊为心绞痛、慢性咽喉炎、慢性支气管炎、支气管哮喘等疾病的胃食管反流病患者的临床资料,探讨误诊原因。结果采用奥美拉唑和莫沙必利治疗,所有病例症状均明显缓解。结论胃食管反流病非典型临床表现有隐匿、多样化的特点,临床医生加强对胃食管反流病的临床和基础知识的认识,是避免和减少误诊的关键。     

小儿胃食管反流病误诊误治90例临床讨论

目的 探讨小儿胃食管反流病误诊误治的原因,提高儿科医师对该病的诊断水平.方法 回顾分析我院2005年9月-2010年9月误诊误治的小儿胃食管反流病90例的临床资料,结合其临床特点,总结误诊误治的原因.结果 本组误诊为心肌炎30例,咳嗽变异型哮喘25例,支气管哮喘20例,重度营养不良、癫痫、先天性遗传代谢性疾病各5例;误诊时间半年～2年.50例经胃食管造影、30例经食管内镜检查确诊为小儿胃食管反流病,10例经试验性治疗后确诊.90例经改变体位、调整饮食及口服药物后症状均缓解.结论 儿科医师对小儿胃食管反流病认识不足、诊断思路局限是导致本病误诊误治的主要原因,进一步提高对该病的认识,可减少或避免误诊、误治.     

胃食管反流病致胃食管喉气管综合征16例误诊为支气管哮喘

胃食管反流病(gastroesophageal reflex disease,GERD)是一种常见的消化道疾病,严重影响着人们的生活质量.但迄今为止,此病尚未引起临床医生的足够重视,常导致误诊和漏诊.我院2000～2008年临床确诊GERD 16例,病初均误诊为支气管哮喘,参照汪忠镐院士2007年提出的胃食管喉气管综合征(gastroesophago larypgtracheal syndrome,GELTS)诊断标准[1],本组均符合GELTS标准.现将误诊情况分析如下.     

胃食管反流病误诊31例分析

目的：分析31例胃食管反流病误诊的主要原因,以降低其误诊率。方法：以误诊的31例为对象进行分析。结果：误诊为咽喉炎18例,冠心病3例,支气管炎2例,贲门失弛缓误诊为胃食管反流病2例,食道裂孔疝误诊为反流性食管炎3例,霉菌性食道炎误诊为胃食管反流病3例。结论：更新知识,开拓思维,适当应用现代诊断和治疗措施,可降低误诊率。     

2010年国际胃食管反流病学术论坛会议征文

2006年4月起,纠正自身胃食管反流病误诊并治疗而愈的中国科学院汪忠镐院士。开始致力于胃食管反流病的临床诊治和发病机制的探究。发现该病不仅引起食管下端反流,更严重的是存在食管上端反流．由于在生理上咽呈闭合状态。使经咽反流通过了一个鸟嘴机制,从而形成了溢出或淤出（spilling）、涌出或呕出（spurting）、     

胃食管反流病误诊为反流性咽喉炎53例诊治分析

目的：探讨长期误诊为反流性咽喉炎的胃食管反流病诊治方法。方法：采用喉镜、胃镜和24 h食管pH监测明确诊断,用抑酸药和胃肠动力药治疗并观察前后的症状。结果：53例患者治疗后有效率为90.57%。其中对糜烂性食管炎有效率为97.14%,非糜烂性反流性咽喉炎有效率为77.78%。结论：喉镜、胃镜和24 h食管pH监测可协同诊断被误诊为反流性咽喉炎的胃食管反流病,采用抑酸药和胃肠动力药治疗能凑效。     

小儿胃食管反流性咳嗽17例分析

目的：探讨小儿胃食管反流性咳嗽（GERC）的临床特征,为临床诊断提供资料。方法：回顾分析2006-01～2006-12在我院诊治的17例小儿胃食管反流性咳嗽的临床资料。结果：17例中有反流症状5例,进食相关性咳嗽11例。诊断方法：X线钡餐2例,胃镜5例,B超1例,食管24 h pH值监测1例,仅通过抗反流诊断性治疗有效确诊8例,全部病例均有误诊经过,误诊时间1～3个月。结论：小儿胃食管反流性咳嗽缺乏典型的临床特征较易误诊,食管24 h pH值监测虽作为诊断胃食管反流的金标准,但小儿及家属难以配合,抗反流诊断性治疗不失为经济、简便而可行的方法。     

Gastro-oesophageal reflux disease

Part two of this article on GORD examines investigations and treatment options once the initial diagnosis of the condition has been made and focuses on the role that nurses can play in helping patients with this condition.     

Gastro-oesophageal reflux in infants: an evidence-based approach

Gastro-oesophageal reflux (GOR) is present in most infants, but is usually a benign condition that resolves by the age of 6 to 12 months as the gastrointestinal tract develops. While it lasts, however, reflux symptoms can be very worrying for parents, and community nurses are well placed to provide them with reassurance, support and advice on practical measures that will improve symptoms in most cases. Nurses also have an essential role in monitoring infants for possible progression of symptoms to complicated GOR or gastro-oesophageal reflux disease (GORD), and in ensuring that such babies, and those with a possible underlying abnormality, receive appropriate referral for further investigation and medical or surgical treatment.     

The Diagnosis and Treatment of Gastro-oesophageal Reflux Disease in Infants and Children

Gastro-oesophageal reflux is a common phenomenon in infants, and is an aspecific complaint. The balance between negligence and overconcern is therefore very difficult to make, and requires experienced physicians. The approach in infants with uncomplicated reflux consists of non-drug treatment and reassurance of the parents about the almost physiological nature of the regurgitations of the baby. If the parents persist in their complaints, the administration of prokinetics such as cisapride can be considered before performing investigations (oesophagel pH monitoring). The efficacy and the lack of side-effects of cisapride makes this the drug of choice. The frequency of side-effects of other drugs necessitates the diagnosis of reflux disease before their administration.

Upper gastrointestinal tract endoscopy is the investigation of choice in children suspected of reflux oesophagitis. In the majority of cases, the efficacy of cisapride, H₂-blockers and Na-K-ATP-ase-blockers should be given a chance. Unusual presentations, such as chronic respiratory disease, as a manifestation of reflux disease should be confirmed with oesophageal pH monitoring.     

Gastro-oesophageal reflux disease increases the risk of intensive care unit admittance and mechanical ventilation use among patients with chronic obstructive pulmonary disease: a nationwide population-based cohort study

IntroductionGastro-oesophageal reflux disease (GORD) is common among chronic obstructive pulmonary disease (COPD) patients and may have a deleterious effect on COPD prognosis. However, few studies have investigated whether GORD increases the risk of severe outcomes such as intensive care unit (ICU) admittance or mechanical ventilator use among COPD patients.MethodsPropensity score matching by age, sex, comorbidities and COPD severity was used to match the 1,210 COPD patients with GORD sourced in this study to 2,420 COPD patients without GORD. The Kaplan-Meier method was used to explore the incidence of ICU admittance and machine ventilation with the log rank test being used to test for differences. Cox regression analysis was used to explore the risk of ICU admittance and mechanical ventilation use for patients with and without GORD.ResultsDuring the 12-month follow-up, GORD patients and non-GORD patients had 5.22 and 3.01 ICU admittances per 1000 person-months, and 4.34 and 2.41 mechanical ventilation uses per 1000 person-month, respectively. The log rank test revealed a difference in the incidence of ICU admittance and machine ventilation between the two cohorts. GORD was found to be an independent predicator of ICU admittance (adjusted hazard ratio (HR_adj) 1.75, 95% confidence interval (CI) 1.28-2.38) and mechanical ventilation (HR_adj 1.92, 95% CI 1.35-2.72).ConclusionThis is the first investigation to detect a significantly higher incidence rate and independently increased risk of admission to an ICU and mechanical ventilation use among COPD patients who subsequently developed GORD during the first year following their GORD diagnosis than COPD patients who did not develop GORD.

Electronic supplementary material

The online version of this article (doi:10.1186/s13054-015-0849-1) contains supplementary material, which is available to authorized users.     

Structured management strategy based on the Gastro-oesophageal Reflux Disease (GERD) Questionnaire (GerdQ) vs. usual primary care for GERD: pooled analysis of five cluster-randomised European studies

Background: Response to treatment among primary care patients with gastro‐oesophageal disease (GERD) is variable. Aim: The GERD Management Project (GMP) evaluated the effectiveness of a structured management approach to GERD vs. standard treatment (usual care). Methods: Data from five cluster‐randomised clinical trials in adult primary care patients with symptoms of GERD were pooled. The structured pathway was based on the self‐administered GERD Questionnaire (GerdQ) and was compared with standard treatment. Results: 1734 patients were enrolled (structured treatment, n = 834; standard treatment, n = 900). The difference in the mean GerdQ score change from baseline favoured the structured pathway (?0.61; 95% CI: ?0.88, ?0.34; p < 0.001). The odds ratio for an indication for treatment revision at the end of follow‐up (structured vs. standard treatment) was 0.39 (95% CI: 0.29, 0.52; p = 0.001). Conclusions: Management of primary care patients with GERD can be improved by systematic stratification of patients using a patient management tool such as the GerdQ.