磁性括约肌增强装置治疗胃食管反流病的研究进展

胃食管反流病是指胃内容物反流入食管,引起不适症状和（或）并发症的一类疾病。据报道,对于胃食管反流病患者,磁性括约肌增强装置是抗反流手术的一种创新替代方法。尽管已在实践中使用,但对其评估方式知之甚少。本文于中英文数据库中检索出自2001年1月至2020年2月相关研究共51篇,并从机制、手术技术、效果评估、术后并发症及经济效益方面做出归纳总结。旨在系统性地总结和评估磁性括约肌增强装置在临床实践中的应用。     

下食管括约肌运动和功能与胃食管反流病

目的　观察胃食管反流病 (GERD)患者与对照组餐前、餐后食管pH情况 ,下食管括约肌(LES )运动模式的变化以及酸反流事件与一过性下食管括约肌松弛 (TLESR )、低LES压力 (LESP)的关系。方法　两组受试者均接受连续性 4h食管压力测定 (分别为空腹和餐后 1、2、3h)和食管pH监测 (GERD组检测 4h ,对照组检测 2 4h)。结果　GERD组酸反流事件明显高于对照组 (P <0 0 5 )。两组间TLESR发生率差异无显著性 (P >0 0 5 ) ,但与空腹比较 ,两组餐后 1h和 2hTLESR发生率明显增多 ;GERD组伴有酸反流的TLESR明显高于对照组 (P <0 0 0 1)。 4 3% (2 9/ 6 8)的酸反流事件发生在TLESR期间。 31% (2 1/ 6 8)的酸反流事件出现于低LESP状态中。结论　GERD是多因素参与的病理过程。LES运动形式变化和功能不全是GERD的重要背景因素。     

难治性与非难治性胃食管反流病食管动力比较

目的 :比较难治性胃食管反流病(RGERD)与非RGERD食管动力特点的差异。方法 :回顾分析2011年5月至2014年5月我院消化科进行高分辨率食管测压的GERD患者86例,其中RGERD组44例,非RGERD组42例,比较2组患者食管动力特点的差异。结果:RGERD组与非RGERD组食管下括约肌(LES)长度分别为(2.6±0.7)和(3.5±0.9)cm,LES静息压分别为(16.3±8.0)和(20.3±8.6)mmHg(1 mmHg=0.133 kPa),远端波波幅分别为(65.7±30.1)和(80.1±34.9)mmHg,食团内压(IBP)分别为(11.6±4.0)和(13.6±3.7)mmHg,差异有统计学意义(t=5.128、2.235、2.044、2.400,均P0.05)。2组小型蠕动中断百分比差异有统计学意义(P0.05)。结论:LES长度较短、LES静息压偏低、远端波波幅偏低、IBP偏低及小型蠕动中断百分比增加是RGERD的主要食管动力障碍,调控这些因素或许可以为RGERD的治疗提供新的方向。     

LINX抗反流系统治疗胃食管反流病的研究进展

胃食管反流病(gastroesophageal reflux disease,GERD)是由食管下段括约肌(lower esophageal sphincter,LES)功能不全导致胃、十二指肠内容物反流入食管、口腔或气管引起不适症状和(或)并发症的一种疾病。其主要症状为烧心和反流。目前GERD的主要治疗方法包括药物、内镜及外科手术。但需长期服用质子泵抑制剂,且术后并发症多或疗效不确切。LINX抗反流系统是近年来兴起的一种新型治疗技术,在疗效上具有其独特的优势。该文就LINX抗反流系统治疗GERD的研究进展作一综述。     

胃食管反流病发病机制研究进展

胃食管反流病(GERD)是一种临床常见病,迄今为止其发病机制尚未阐明。此文就近年来GERD发病机制的研究进展作一综述,有助于采取更合理的治疗。     

药穴指针疗法治疗胃食管反流病患者食管下括约肌压力的变化

[目的]观察药穴指针疗法治疗胃食管反流病（GERD）患者食管下括约肌压力（LESP）的变化,探索其作用机制。[方法]863例GERD患者均予药穴指针疗法治疗,每次操作15min,每日2次。3周为1个疗程。[结果]与治疗前相比,LESP有明显改善（P〈0．05）,未见明显不良反应。[结论]药穴指针疗法治疗GERD疗效较好,能明显提高患者的LESP,无明显的不良反应。     

抗反流黏膜消融术治疗难治性胃食管反流病1例

<正>胃食管反流病(gastroesophageal reflux disease, GERD)在世界范围内的患病率约为8%～33%,并呈逐年升高的趋势。严重的GERD会极大地降低患者的生活质量,并带来巨大的医疗成本^[1-2]。抑酸治疗是GERD首选的治疗方式,然而部分患者通过规范的抑酸治疗4～8周,甚至更长时间后,仍不能完全控制反流相关的症状。使用双倍标准剂量、8周疗程的抑酸剂治疗后,反流、烧心等症状未见明显改善的患者,被定义为难治性GERD^[3-5]。     

难治性胃食管反流病诊断方法的研究进展

众多学者把质子泵抑制剂(proton pump inhibitors,PPIs)治疗不应答的胃食管反流病(gastroesophageal reflux disease,GERD)称为难治性胃食管反流病,本病是当前消化系统疾病谱中最为顽固的治疗难题之一.近年来众多研究者运用多种诊察手段来研究本病,希望找到该病的发病机制.本文就最近国内外有关难治性GERD的诊断方案,发病机制及相关研究结果等内容作一综述.     

康复新联合奥美拉唑治疗难治性胃食管反流病25例

[目的]观察康复新及奥美拉唑联合运用治疗难治性胃食管反流病(GERD)的疗效。[方法]将难治性GERD50例随机分为2组,A组于清晨空腹及晚上睡前服用奥美拉唑20mg,康复新10ml,3次/d;B组用奥美拉唑,用法同A组,2组疗程均为8周。疗程结束后,复查胃镜,观察比较食管炎及反流等症状的改善程度。[结果]A组,临床症状总有效率84.0%,B组为56.0%(P<0.05);胃镜检查评价,A组总有效率为96.0%,B组为72.0%(P<0.05)。[结论]康复新联合奥美拉唑治疗GERD有较好的疗效。     

Safety analysis of first 1000 patients treated with magnetic sphincter augmentation for gastroesophageal reflux disease

Antireflux surgery with a magnetic sphincter augmentation device (MSAD) restores the competency of the lower esophageal sphincter with a device rather than a tissue fundoplication. As a regulated device, safety information from the published clinical literature can be supplemented by tracking under the Safe Medical Devices Act. The aim of this study was to examine the safety profile of the MSAD in the first 1000 implanted patients. We compiled safety data from all available sources as of July 1, 2013. The analysis included intra/perioperative complications, hospital readmissions, procedure‐related interventions, reoperations, and device malfunctions leading to injury or inability to complete the procedure. Over 1000 patients worldwide have been implanted with the MSAD at 82 institutions with median implant duration of 274 days. Event rates were 0.1% intra/perioperative complications, 1.3% hospital readmissions, 5.6% endoscopic dilations, and 3.4% reoperations. All reoperations were performed non‐emergently for device removal, with no complications or conversion to laparotomy. The primary reason for device removal was dysphagia. No device migrations or malfunctions were reported. Erosion of the device occurred in one patient (0.1%). The safety analysis of the first 1000 patients treated with MSAD for gastroesophageal reflux disease confirms the safety of this device and the implantation technique. The overall event rates were low based on data from 82 institutions. The MSAD is a safe therapeutic option for patients with chronic, uncomplicated gastroesophageal reflux disease.     

Pathophysiology of gastroesophageal reflux. Lower esophageal sphincter dysfunction in gastroesophageal reflux disease

LES dysfunction is the principal mechanism responsible for GER disease. Two main patterns of sphincter dysfunction have been identified: an abnormally high rate of transient LES relaxations, and defective basal LES pressure. Overpowering of a weak LES by pressure transients induced by straining is less common than previously thought, at least under conditions tested thus far. Current evidence suggests that LES dysfunction results primarily from defective neural control, although smooth muscle function may also be impaired. Extrinsic mechanisms, particularly the diaphragmatic crura, also appear to be important during straining. The role of hiatus hernia remains unclear but seems likely to contribute to the pathogenesis of reflux disease by impairing LES function.     

Endoscopic management of refractory gastroesophageal reflux disease

Objective: Despite the therapeutic and surgical interventions for the management of gastroesophageal reflux disease (GERD), yet the high cost and the post-operative complications had led to a significant socioeconomic burden. The aim was to evaluate the safety and efficacy of endoscopic band ligation (EBL) in the management of refractory GERD.

Methods: A total of 150 patients with refractory GERD were assigned to an EBL group (banding was done at four quadrants just at the gastroesophageal junction (GEJ) (n?=?75) or to a control group (optimized dose of PPI, n?=?75). Follow-up for both groups by upper GI endoscopy to evaluate the site of the Z line from the incisors, the width of the GEJ and the coaptation of GEJ around the endoscope on retroflection. PH monitoring was performed every 3 months with GERD- QoL assessment monthly for 1 year.

Results: In EBL group; 58 patients (77.3%) needed 1 session, 17 patients (22.7%) needed 2 sessions. 4 rubber bands were utilized in 44 patients (58.7%), 3 rubber bands in 31 patients (41.3%). Follow-up for 1 year revealed a highly significant improvement of the GERD- QoL score, the site of Z line with significant reduction of reflux episodes and symptom index when compared to the medical treatment group. In EBL group; there were no major adverse events including bleeding, post band ulcers, stenosis at one year follow up.

Conclusion: The current study provides a novel endoscopic intervention to treat refractory GERD, which is safe, cost-effective, with no major adverse effects at one year follow up.     

Therapeutic options for refractory gastroesophageal reflux disease

Refractory gastroesophageal reflux disease may affect up to one-third of the patients that consume proton pump inhibitor (PPI) once daily. Treatment in clinical practice has been primarily focused on doubling the PPI dose, despite lack of evidence of its value. In patients who failed PPI twice daily, medical treatment has been primarily focused on reducing transient lower esophageal sphincter relaxation rate or attenuating esophageal pain perception using visceral analgesics. In patients with evidence of reflux as the direct trigger of their symptoms, endoscopic treatment or antireflux surgery may be helpful in remitting symptoms. The role of psychological interventions, as well as non-traditional therapeutic strategies remains to be further elucidated.     

Endoluminal methods of treating gastroesophageal reflux disease

Several endoluminal methods of treating gastroesophageal reflux disease (GERD) have either been approved, or are under investigation and development. This review outlines the two approved methods (Bard's endoluminal sewing machine and Curon's Stretta radiofrequency treatment), and describes the available data on new methods under investigation. The various methods can be divided into three broad categories: methods that create a controlled stricture, methods that bulk the gastroesophageal junction, and methods that attempt to create a fundoplication. The pros and cons of each method are discussed. Unlike medical treatment, these methods attack the reflux itself, not just the symptoms. This is a promising approach. However, the controlled stricture and bulking methods do not approach the success rate of a standard fundoplication.     

Gastric acid hypersecretion in refractory gastroesophageal reflux disease

We prospectively evaluated gastric acid output (mEq/h), gastric volume output (ml/h), ambulatory 24-h esophageal pH monitoring, and the endoscopic appearance of the esophagus in 23 patients undergoing treatment of chronic long-standing pyrosis. Twelve of these 23 individuals (52%) remained symptomatic after 3 mo of standard antisecretory treatment with ranitidine, 150 mg twice daily. When compared with initial responders, those patients who did not experience complete symptomatic relief on therapy had significantly higher basal acid output (p less than 0.001), basal volume output (p less than 0.02), and basal upright (but not supine) reflux time (p less than 0.05). Nine of the 12 patients who did not respond to initial treatment had gastric acid hypersecretion (basal acid output greater than 10 mEq/h), and 10 of the 12 had Barrett's epithelium compared with only 1 patient in the initial-responder group (p less than 0.001). All 12 nonresponders were treated for an additional 3 mo with increased doses of ranitidine (mean, 1280 mg/day; range, 600-1800 mg/day), and complete disappearance of pyrosis occurred in 10 of the 12, although no significant endoscopic regression was observed in the extent of the underlying columnar mucosa in those with Barrett's esophagus over the 6-mo duration of the study. A significant correlation was shown between the daily ranitidine dose required to eliminate symptoms and the pretreatment basal acid output (r = 0.81, p less than 0.001); gastric acid output had to be almost totally suppressed (i.e., less than 1 mEq/h) for pyrosis to disappear completely. No side effects occurred with any of these high doses of ranitidine. We conclude that a subgroup of patients with long-standing symptomatic gastroesophageal reflux disease who do not respond to standard ulcer-healing doses of histamine2-receptor antagonists are hypersecretors of basal gastric acid and require increased acid-suppressive therapy. Many of these individuals also have underlying Barrett's epithelium.     

难治性胃食管反流病的诊疗

难治性胃食管反流病目前已成为临床上的棘手问题。其发生机制尚未完全阐明。上消化道内镜、食管内动态pH监测以及食管多通道腔内阻抗-pH值监测等技术能够对难治性胃食管反流病的诊断提供帮助。通过改善患者的服药依从性以及调整质子泵抑制剂的剂量、种类和服药时间,配合促胃肠动力药、一过性下食管括约肌松弛抑制剂、疼痛调节剂或抗反流手术均有助于改善患者的顽固症状。