内镜抗反流黏膜切除术治疗难治性胃食管反流病一例

胃食管反流病(GERD)是指胃或十二指肠内容物反流至食管引起不适症状和/或并发症的一种疾病,以烧心和反流为典型表现。大多数糜烂性胃食管反流病患者的病变程度为轻度（洛杉矶分级 A 级患者占 50-90%）,因此,目前对GERD的治疗主要依靠质子泵抑制剂（PPI）。但仍有一部分患者PPI治疗疗效甚微。目前亚太的共识认为：在常规PPI剂量治疗至少 8 周反流症状仍无缓解的 GERD 可以定义难治性胃食管反流病（Refractory GERD,RGERD）。对于RGERD的治疗,最近内镜下出现了一种新的治疗方法——抗反流黏膜切除术(ARMS),初步报导可以有效地重塑贲门抗反流屏障,改善患者症状。在这篇报告中,我们将介绍国内首例通过抗反流黏膜切除术(ARMS)治疗难治性胃食管反流病的病例。     

抗反流黏膜切除术治疗胃食管反流病的临床疗效观察

目的 评价抗反流黏膜切除术治疗胃食管反流病的临床有效性和安全性。 方法 2015年12月至2018年7月,郑州大学第一附属医院消化内科行抗反流黏膜切除术的18例胃食管反流病病例资料纳入回顾性研究,统计治疗效果（治疗后烧心及反流症状改善情况、24 h食管pH监测结果等）以及并发症发生情况。 结果 18例均成功进行了抗反流黏膜切除术,操作成功率为100%,其中8例行ESD、10例行EMR。24 h食管pH监测结果显示,治疗后Demeester评分、pH＜4时间百分比、总反流事件、pH＜4时间长于5 min的反流次数较术前均明显降低[（20.16±9.12）分比（74.16±20.03）分、（2.70±0.88）%比（6.42±1.37）%、（43.78±19.68）次比（156.56±41.22）次、（2.89±1.68）次比（9.89±2.95）次,P均＜0.05]。无术后出血、穿孔、感染病例。随访3～34个月,烧心及反流症状改善总有效率为89%（16/18）。胃镜随访显示18例贲门均较前缩紧,收缩良好;16例反流性食管炎较前明显好转,黏膜糜烂愈合。 结论 抗反流黏膜切除术治疗胃食管反流病安全有效,且简单易行。     

内镜下抗反流黏膜切除术治疗质子泵依赖性胃食管反流病的短期疗效观察

2017年7月—2020年12月间,在南京鼓楼医院行内镜下抗反流黏膜切除术（anti?reflux mucosectomy,ARMS）治疗的26例质子泵抑制剂依赖性胃食管反流病连续病例纳入回顾性分析,主要比较手术前后的反流症状评分（GERD?Q评分）、生活质量评分（RQS评分）、食管动力及24 h测酸检查结果。结果发现：中位随访18.4个月（6～27个月）,23例（88.5%）临床症状得到明显缓解,15例（57.7%）停用质子泵抑制剂,平均GERD?Q评分（6.23分比13.19分,P=0.004）和平均RQS评分（26.67分比10.98分,P<0.001）均较术前明显好转,平均DeMeester评分（10.69分比53.15分,P<0.001）、平均酸反流时间百分比（3.56%比9.92%,P<0.001）、平均酸反流总次数（36.9次比139.9次,P=0.001）均明显低于术前,平均食管下括约肌静息压（25.19 mmHg比13.63 mmHg,P<0.001）和平均远端收缩积分（1 819.15 mmHg·s·cm比1 007.67 mmHg·s·cm,P<0.001）均较术前明显增加。提示ARMS治疗质子泵抑制剂依赖性胃食管反流病短期疗效显著,可有效改善患者的反流症状和生活质量,增加患者的食管下括约肌静息压和食管体部蠕动。     

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]。     

胃食管反流病的内镜治疗进展

胃食管反流病(GERD)是指过多的胃、十二指肠内容物反流入食管引起烧心等症状,伴食管pH的改变,内镜检查可见食管黏膜糜烂等的一种表现。若仅有症状或食管pH改变,内镜检查阴性,则称为内镜阴性GERD或非糜烂性胃食管反流病(NERD)。目前认为短暂性食管下端括约肌(LES)松弛是GERD的最主要原因。     

胃食管反流病的内镜治疗进展

胃食管反流病是一种常见的上消化道动力障碍疾病，目前的治疗主要是抑制胃酸分泌药物和腹腔镜Nissen胃底折叠术。内镜抗反流治疗技术是近几年出现的很有前景的新方法，包括内镜下缝合术、射频治疗技术和内镜下植入治疗等，这些方法都取得较好的效果。此文就胃食管反流病的内镜治疗方面的进展作一综述。     

抗反流药物:治疗胃食管反流病的新方法

<正> 一、抗反流药物的概念未来几年内,通过阻断一过性下食管括约肌松弛(transient lower esophageal sphincter relaxations,TLESR)以达减少反流目的的抗反流药物可望成为胃食管反流病的治疗新选择。尽管反流病的病理生理学十分复杂,但大量异常反流物反流无疑是其关键性驱动力。抗反流手术的成功率很高,但抗反流药物治疗反流病的想法亦可行,这是由于"反流病     

难治性胃食管反流病的非药物治疗进展

胃食管反流病(GERD)是一种常见的上消化道疾病。目前质子泵抑制剂(PPI)是治疗该病的首选药物,但约40%GERD患者经规范治疗后疗效不佳,即难治性GERD,且易合并不同程度的精神心理症状,严重降低患者生活质量。因此积极探索一些非药物治疗手段成为近年来rGERD相关研究的热点。本文就生活方式的调整、穴位刺激、膈肌生物反馈、内镜下治疗、外科手术等rGERD非药物治疗方法进展做一综述。     

胃食管反流病的内镜治疗现状

胃食管反流病(gastroesophageal reflux disease．GERD)是指胃或十二指肠内容物反流入食管，引起并发症或明显地损害了病人的生活质量。主要表现为烧心、反酸或食物反流，可引起食管糜烂、溃疡、出血、狭窄等。GERD非常常见，西方国家约10％的人患有此病，老年人约1／4患有GERD。我国该病的发病率具体不详，京沪二地调查约6％的人患有GERD。GERD的     

Efficacy of Rabeprazole in the Treatment of Symptomatic Gastroesophageal Reflux Disease

The purpose of this study was to assess the rapidity of symptom relief and 4-week efficacy of rabeprazole 20 mg in patients with moderately severe nonerosive gastroesophageal reflux disease. Data were analyzed from 2 similarly designed, double-blind, placebo-controlled, multicenter, U.S. trials. After a 2-week placebo run-in period, patients (N = 261) were randomized to 4 weeks of rabeprazole 20 mg once daily or placebo. Patients kept symptom diaries and scored symptom severity. Median time to first 24-hour heartburn-free interval was 3.5 days for the rabeprazole group compared with 19.5 days for the placebo group (P ≤ .0002). Complete heartburn relief at week 4 was 32% with rabeprazole and 3.8% with placebo (P ≤ .001). Rabeprazole also significantly improved other GERD-associated symptoms (e.g., regurgitation, belching, early satiety) by week 4 compared with placebo (P ≤ .05). Rabeprazole provides fast and potent relief from heartburn and other symptoms of nonerosive gastroesophageal reflux disease. Supported by Eisai Inc., Teaneck, New Jersey, and Janssen Pharmaceutica Inc., Titusville, New Jersey.     

Ineffective Esophageal Motility Is a Primary Motility Disorder in Gastroesophageal Reflux Disease

The relationship between esophageal motor abnormalities and GERD has been widely studied. The purpose of this study was to identify the prevalence of ineffective esophageal motility (IEM) in patients with GERD. In addition, we also evaluated esophageal acid exposure, acid clearance, and endoscopic esophagitis in GERD patients with IEM. Of 89 patients enrolled in this study, 47 (52.8%) were found to have nonspecific esophageal motility disorder (NEMD). Forty-four of the 47 (93.6%) patients with NEMD met the diagnostic criteria for IEM. The overall incidence of IEM in GERD patients was 49.4%. Patients with IEM had significant increases in upright and recumbent mean fraction of time pH < 4 (6.70% and 4.38%) and mean recumbent esophageal acid clearance (12.45 min/reflux) when compared to those with other motility findings. Seventeen of the 44 (39%) IEM patients did not have endoscopic esophagitis. On the other hand, 26 of the 39 (67%) patients with normal manometry had endoscopic esophagitis. We concluded that not only is the prevalence of IEM high in GERD, but also that IEM patients have more recumbent gastroesophageal reflux and delayed acid clearance. Combined with endoscopic findings, we propose that IEM can be viewed as a specific entity of primary esophageal motility disorder in patients with GERD.     

Usage of Supplemental Alternative Medicine by Community-Based Patients with Gastroesophageal Reflux Disease (GERD)

There is an increasing trend towards alternative medicine usage by the general US population. However, the extent and type of supplemental alternative medicine used specifically by community-based patients with GERD is unknown. A previously validated questionnaire that included questions about patient demographics, 18 types of alternative medicine, and attitudes towards alternative and conventional medicine was utilized. Consecutive patients seen by community-based physicians in Arizona (Tucson, Phoenix, and Flagstaff) and Wisconsin (Milwaukee) for GERD received the questionnaire during the years 1999 and 2000. Patients completed the questionnaire and returned it to the Tucson VA Medical Center by mail. A total of 185 patients were surveyed (82 men, mean age 55.8 years). Of those, 61.6% used alternative medicine for any reason. However, only 3.8% of patients used supplemental alternative medicine for GERD. Females were twice as likely (95% CI, 1.10–3.67) to use alternative medicines for any reason (including GERD). Patients with daily acid regurgitation were 5.75 times (95% CI, 1.03–32.17) more likely than patients with less frequent acid regurgitation to use alternative medicines specifically for GERD. None of the other demographics, health characteristics, or attitudes were predictive of supplemental alternative medicine use for any reason (or specifically for GERD). In conclusion, only a small percentage of GERD patients seen by community-based practitioners use supplemental alternative medicine specifically for GERD symptoms, despite a higher usage of supplemental alternative medicine for non-GERD-related illness. Being female and having acid regurgitation daily were positively associated with alternative medicine usage for GERD.     

One-week Esomeprazole Treatment: an Effective Confirmatory Test in Patients with Suspected Gastroesophageal Reflux Disease

Background: Symptomatic response to acid inhibition can be used as a guide in diagnosing patients with reflux symptoms. The proton-pump inhibitor (PPI) omeprazole has been used as such a diagnostic tool. Intragastric acid control with esomeprazole is more effective than other PPIs and has the potential to offer an advance in the diagnostic use of PPIs. Methods: Patients experiencing heartburn (for ≥6 months) were studied in this randomized, double-blind, multicenter study. Following a 3-day placebo run-in, 440 patients were randomized to 14 days' treatment with esomeprazole 40 mg once daily (o.d.), esomeprazole 20 mg twice daily (b.i.d.) or placebo. Heartburn symptoms were recorded daily. Endoscopy and 24-h esophageal pH-monitoring were performed to determine the presence of gastroesophageal reflux disease (GERD). The esomeprazole treatment test was considered positive if patients' symptoms improved during the treatment period compared with symptoms recorded on Day 0. Results: 63 patients were excluded from the analysis due to lack of symptoms on Day 0 or failure to complete pH-monitoring. The sensitivity of an esomeprazole treatment test in confirming GERD increased during the first days of treatment and stabilized between 79% and 86% after 5 days (both esomeprazole arms). The corresponding figure for the placebo arm was 36%. Specificity was variable (24%-65%) for both active treatment and placebo. Conclusion: A treatment test with esomeprazole 40 mg has a high sensitivity in confirming GERD. Furthermore, the data indicate that 1-week treatment with a once-daily dosage is sufficient to ensure adequate diagnosis.     

Gastroesophageal Reflux Disease: Review of Presenting Symptoms, Evaluation, Management, and Outcome in Infants

We conducted a retrospective review of 342 infants presenting with symptoms suggestive of gastroesophageal reflux disease (GERD) to assess their evaluation, management, and outcome. All infants underwent extended pH monitoring (EPM) for one or more of the following symptoms: regurgitation, choking, irritability, failure to thrive, apparent life-threatening event, or wheezing. EPM was considered abnormal if distal reflux index was 5% and/or if the Euler and Byrne score was 50 and these patients were labeled as having GERD. Those with normal EPM parameters were controls. All infants were <1 year of age (198 boys, 144 girls). Most received conservative treatment with formula changes and/or thickening and positional management before EPM. Of 342 infants studied, EPM was normal in 169 patients, ie, controls, and GERD was present in 173 children. GERD was more prevalent in Caucasians compared to African Americans (P < 1 0.045). Although a prokinetic or acid suppression medication or both were given more commonly in infants with GERD, almost half of infants in the control group also needed pharmacotherapy because of persistent symptoms. Mean time to resolution of symptoms in the control group infants with normal EPM was 3.5 months, and in infants with GERD it was 5.4 months (P < 0.001). In conclusion, the Majority of infants with symptoms suggestive of GERD resolve their symptoms within 3–6 months of initiating treatment. Day-to-day variability of the spectrum of GERD may contribute towards normal results of EPM in some infants who need pharmacotherapy.     

Rabeprazole Versus Omeprazole in Preventing Relapse of Erosive or Ulcerative Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a chronic condition, with 50–80% of patients experiencing recurrence within one year of completing initial treatment. In patients with erosive GERD, proton-pump inhibitors (PPI) provide faster healing and symptom relief than do H₂-receptor antagonists and have become the treatment of choice. Rabeprazole is a new PPI with demonstrated efficacy in both the acute and maintenance treatment of erosive GERD. The primary objective was to compare efficacy and tolerability of rabeprazole and omeprazole in preventing relapse of healed erosive GERD. Secondary objectives included comparison of efficacy in preventing GERD relapse symptoms and in maintaining quality of life. In this multicenter, double-blind, parallel-group study, 243 patients with healed erosive GERD were randomised to receive rabeprazole 10 mg once daily in the morning (QAM) (N = 82); rabeprazole 20 mg QAM (N = 78); or omeprazole 20 mg QAM (N = 83). Endoscopies were performed at weeks 13, 26, 39 (if clinically indicated), and 52, or when symptoms suggested recurrence. Corpus biopsies were performed at each endoscopy, and antral biopsies were performed at study entry and exit. Rabeprazole 10 mg and 20 mg QAM were equivalent to omeprazole 20 mg QAM for all efficacy parameters. At week 52, relapse rates in the intent-to-treat populations were 5%, 4%, and 5% for rabeprazole 10 mg and 20 mg and omeprazole 20 mg, respectively. All treatments were well tolerated. In conclusion, both rabeprazole 10 mg and 20 mg QAM are equivalent to omeprazole 20 mg QAM in preventing recurrence of erosive GERD.     

内镜下抗反流黏膜切除术和贲门缩窄术治疗胃食管反流病的临床疗效对比

目的 对比内镜下抗反流黏膜切除术（anti-reflux mucosectomy,ARMS）和贲门缩窄术（endoscopic cardial constriction ligation,ECCL）治疗胃食管反流病的临床疗效。方法 回顾性分析2015年12月—2018年8月在郑州大学第一附属医院行ARMS或ECCL治疗,并定期随访的48例胃食管反流病患者病例资料,其中20例行ARMS（ARMS组）,28例行ECCL（ECCL组）,比较两种术式短期及长期临床疗效。结果 两种术式的操作成功率均为100.0%,ECCL组手术时间明显短于ARMS组[（8.43±1.59）min比（34.05±12.35）min,t=－9.227,P＜0.001]。术后2个月随访,ECCL组和ARMS组症状改善有效率分别为89.3%（25/28）和60.0%（12/20）,差异有统计学意义（χ2=4.128,P=0.042）,ECCL组GERD Q评分低于ARMS组[（6.24±1.22）分比（7.35±1.79）分,t=-2.400,P＝0.023]。术后1年随访,两组症状改善有效率、GERD Q评分,以及DeMeester评分和pH＜4时间百分比差异均无统计学意义（P＞0.05）。结论 ARMS和ECCL治疗胃食管反流病的长期临床疗效相当,但ECCL短期疗效更具优势。     

Seronegative Celiac Disease in Patients with Isolated Refractory Dyspepsia and Gastroesophageal Reflux Disease

Background/AimsTo investigate the presence of seronegative celiac disease in patients with isolated refractory dyspepsia and gastroesophageal reflux disease (GERD)-related complaints.MethodsThis was a single-center, prospective study performed at a tertiary care referral hospital. Among 968 consecutive patients, 129 seronegative patients with tissue damage consistent with Marsh IIIa classification or above were included. The patients were divided into two groups dyspepsia (n=78) and GERD (n=51). Biopsies were taken from the duodenum regardless of endoscopic appearance, and patients with Marsh IIIa or above damage were advised to consume a gluten-free diet. The Glasgow Dyspepsia Severity (GDS) score, Reflux Symptom Index (RSI), and Biagi score were calculated at baseline and every 3 months. Control endoscopy was performed every 6 months during follow-up.ResultsThe median follow-up time was 19.9 months (range, 6 to 24 months) in the dyspepsia group and 19.2 months (range, 6 to 24 months) in the GERD group. All the patients were positive for the HLA-DQ2 and DQ8 haplotypes. The differences between the mean GDS scores (14.3±2.1 vs 1.1±0.2, respectively, p<0.05), RSI scores (6.3±0.8 vs 0.7±0.1, respectively, p<0.05), and Biagi scores (3.1±0.4 vs 0.7±0.3 in the dyspepsia group and 2.5±0.4 vs 0.5±0.2 in GERD group) before and after implementation of the gluten-free diet were statistically significant. The decreases in the scores were consistent with improvements in the histological findings. There was no significant correlation between endoscopic appearance and histological examination results (p=0.487).ConclusionsSeronegative celiac disease may be considered in this group of patients. Even if a patient is seronegative and has normal endoscopic findings, duodenal biopsy should be considered.