难治性胃食管反流病的诊疗策略

胃食管反流病（GERD）是临床常见疾病，约30%~50%的患者症状在质子泵抑制剂（PPI）治疗后不能得到完全缓解，其中难治性GERD占较大比例。pH阻抗监测、高分辨率食管测压、内镜及活检等有助于分析导致难治性GERD发生的原因。其中，pH阻抗对分析导致难治性GERD成因非常重要。反流后吞咽诱发蠕动波指数（PSPWI）和夜间平均基线阻抗（MNBI）这两个新指标有助于提高诊断率。难治性GERD的治疗手段包括更换PPI种类、加用H2受体阻滞剂、辅以促动力药物、外科手术、内镜下治疗等。个体化治疗策略的制定有赖于难治性GERD的具体成因。

Diagnosis and treatment strategy for refractory gastroesophageal reflux disease

Gastroesophageal reflux disease(GERD)is a common disease in clinic.About 30%-50% of patients with reflux symptoms report inadequate symptom control with proton pump inhibitor(PPI)therapy,and some cases are refractory GERD.Impedance-pH monitoring,high resolution manometry of esophagus,endoscopy and biopsy help to analyze the reason of refractory GERD.Impedance-pH monitoring plays an important role in it.New impedance parameters,namely the postreflux swallow-induced peristaltic wave(PSPW)index and mean nocturnal baseline impedance(MNBI),have significantly increased the diagnostic rate.Another type of PPI,histamine 2 receptor antagonists,endoscopic therapy,surgery,and prokinetic agents are different options available for the management of refractory GERD.Individualized treatment strategy may depend on the cause of refractory GERD.