The indications for biopsy in routine upper gastrointestinal endoscopy

This review describes the indications and contraindications for endoscopic biopsy, in routine practice, of the upper gastrointestinal (GI) tract. We accept that this review provides grounds for controversy, as our stance in certain situations is counter to some national guidelines. Nevertheless, we provide evidence to support our viewpoints, especially on efficiency and economic grounds. We describe the particular controversies concerning the biopsy assessment of Barrett's oesophagus, chronic gastritis and the duodenum in the investigation of coeliac disease. We accept that there are indications for more extensive upper GI biopsy protocols in children than in adults; the latter constitute our main focus in this article. We would encourage detailed discussion between pathologists and their endoscopy colleagues about the indications, or lack of them, for routine upper GI endoscopic biopsy, as studies have shown that adherence to agreed guidelines has resulted in a very considerable diminution in the biopsy workload without compromising patient management. Furthermore, where biopsy is indicated, we emphasise the importance of accompanying clinical information provided to the pathologist, in particular regarding biopsy site(s), and regular feedback to endoscopists to improve and maintain the quality of such information. Finally, local dialogue is also advised, when necessary, to indicate to endoscopists the need to appropriately segregate biopsies into separate, individually labelled specimens, to maximise the information that can be derived by pathological evaluation and thereby improve the quality of the final pathology report.     

难治性胃食管反流病的原因和中医药诊治策略

胃食管反流病是临床常见病,病理机制复杂,临床症状多样,采用单一治疗方式对部分患者难以奏效,易导致病情迁延而发展成为难治性胃食管反流病。目前国内外对难治性胃食管反流病并无确切的定义和诊断标准,也无统一的治疗方案。中医辨证治疗能够改善患者精神心理状态,提高生命质量,疗效较好。     

食管癌、贲门癌切除术后胃食管反流的临床分析

目的：探讨食管癌、贲门癌切除术后胃食管反流的发生机制、抗反流措施和抗反流的手术方法及治疗。方法：左侧开胸食管癌、贲门癌切除术208例,其中颈部吻合86例,越过主动脉弓上吻合78例,主动脉弓下吻合44例,临床资料进行比较分析。结果：胃食管反流十分普遍,发病率较高达88%。208例中84例手术后出现胃食管反流症状,发生率40.3%,主动脉弓下吻合胃食管反流比例〉主动脉弓上吻合〉颈部吻合。结论：食管癌贲门癌切除术后吻合平面越高,反流越轻,食管胃颈部吻合术式具有更好的减轻术后胃食管反流的作用,能改善病人的术后生活质量。     

多潘立酮治疗婴儿胃食管反流相关性肺炎的疗效观察

目的:观察多潘立酮治疗婴儿胃食管反流相关性肺炎的效果.方法:45例2～8月确诊为胃食管反流相关性肺炎的婴儿,随机分为治疗组26例和对照组19例,对照组予改变体位和少量多次进食等方法,治疗组在对照组的基础上加用多潘立酮混悬液0.2 mg/(kg·次),一日4次,分别于早、中、晚餐及夜间10点喂奶前15～30 min服用,疗程2周.结果:治疗组显效、有效分别为11例和13例,总有效率91.6%;对照组显效、有效分别为5例和7例,总有效率63.2%,两组比较差异具有统计学意义(X2=5.83,P＜0.05).治疗组和对照组住院天数分别为(10.62±2.4)d、(15.23±5.2)d,差异有统计学意义(t=3.99,P＜0.05).治疗组未见明显不良反应.结论:多潘立酮治疗婴儿胃食管反流相关性肺炎经济安全有效.     

胃食管反流病致重度牙齿侵蚀的固定-活动联合修复

目的:探讨用固定-活动义齿联合修复,对胃食管反流病致重度牙齿侵蚀症患者进行咬合重建的临床效果。方法:对从2010年1月~2013年10月来我院就诊的10例胃食管反流病致重度牙侵蚀症患者采用诊断义齿过渡3~6个月,患者适应后再以诊断义齿为依据,采用固定-活动联合修复行咬合重建。分别于修复后3个月、6个月、1年、2年、3年复查。复查内容:修复体完整性、咬合稳定性、美观度、患者使用满意度。结果:整个随访期间,10例咬合重建患者面部外形改善,咀嚼功能恢复良好,患者对义齿的美观及舒适性均较为满意,配合用药后食管反流症状基本消失。结论:用固定-活动义齿联合修复,进行牙合重建能恢复患者美观,提高咀嚼功能同时后期维护简便。     

巨大肺大疱伴胃食管反流1例

肺大疱在临床工作中常见,但是巨大肺大疱伴胃食管反流症状的患者较少见.巨大肺大疱易被误诊为气胸,如果伴有胃食管反流症状,易误诊为胃食管反流性哮喘,本例患者经过正确诊断和手术治疗痊愈,对我们拓宽胃食管反流症状病因的思考非常重要.     

Acid peptic diseases: pharmacological approach to treatment

Acid peptic disorders are the result of distinctive, but overlapping pathogenic mechanisms leading to either excessive acid secretion or diminished mucosal defense. They are common entities present in daily clinical practice that, owing to their chronicity, represent a significant cost to healthcare. Key elements in the success of controlling these entities have been the development of potent and safe drugs based on physiological targets. The histamine-2 receptor antagonists revolutionized the treatment of acid peptic disorders owing to their safety and efficacy profile. The proton-pump inhibitors (PPIs) represent a further therapeutic advance due to more potent inhibition of acid secretion. Ample data from clinical trials and observational experience have confirmed the utility of these agents in the treatment of acid peptic diseases, with differential efficacy and safety characteristics between and within drug classes. Paradigms in their speed and duration of action have underscored the need for new chemical entities that, from a single dose, would provide reliable duration of acid control, particularly at night. Moreover, PPIs reduce, but do not eliminate, the risk of ulcers in patients taking NSAIDs, reflecting untargeted physiopathologic pathways and a breach in the ability to sustain an intragastric pH of more than 4. This review provides an assessment of the current understanding of the physiology of acid production, a discussion of medications targeting gastric acid production and a review of efficacy in specific acid peptic diseases, as well as current challenges and future directions in the treatment of acid-mediated diseases.     

姜树民教授治疗胆汁反流性胃炎经验

胆汁反流性胃炎是因十二指肠液反流入胃所致的以胃黏膜损害为病理表现的疾病。属于祖国医学之胃脘痛、嘈杂、胆瘅、呕苦、胃痞等范畴。导师姜树民教授根据自己多年的科研及临床经验辨证论治总结出了中医治疗BGR的方法,疗效颇佳。