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中华胃食管反流病电子杂志 ›› 2020, Vol. 07 ›› Issue (01) : 1 -28. doi: 10.3877/ cma.j.issn.2095-8765.2020.01.001

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中国胃食管反流病多学科诊疗共识
中国医疗保健国际交流促进会胃食管反流多学科分会   
  • 收稿日期:2019-07-20 出版日期:2020-02-15

Consensus on multidisciplinary diagnosis and treatment of gastroesophageal reflux disease in China

  • Received:2019-07-20 Published:2020-02-15
引用本文:

中国医疗保健国际交流促进会胃食管反流多学科分会. 中国胃食管反流病多学科诊疗共识[J]. 中华胃食管反流病电子杂志, 2020, 07(01): 1-28.

图1 胃食管喉气管综合征分期图
图2 GERD的发病机制
图3 胃食管气道反流综合征的临床表现
表1 儿童GERD症状[49]
表2 LPRD严重程度分类
表3 根据临床特点、检查发现和治疗反应可将GERD分为不同亚型[15]
表4 GERD症状PPI疗效不佳的可能原因[77,78]
表5 有助于确诊GERD的临床情况
表6 警报症状[81]
图4 GERD的主观和客观检查手段
表7 提示GERD患者需要进行客观检查的临床情况
图5 临床上常用检查方法的主要靶点
图6 反流性食管炎采用LA标准[86]和Hill分级评估贲门区的解剖学形态
表8 GEFV分级与GERD的相关性
表9 反流体征评分量表
表10 反流症状指数评分量表
表11 历年pH或pH-阻抗临界值的研究结果对比
图7 抗反流治疗手段
图8 内科至外科循序渐进多 学科多方法综合诊治流程
表12 GERD的治疗药物及其作用机制
药物类型 作用机制 药物名称
PPI 不可逆地与HT-K-ATP酶结合使其失去活性,抑制持续36 h,远远超过了PPI的血浆半衰期(1~2 h)。达到稳定状态需要3 d的治疗时间。需要酸性环境转化为活性物质的前药。不耐酸,通常为肠溶型;抑制乙酰胆碱和组胺释放产生的酸分泌 艾司奥美拉唑、奥美拉唑、雷贝拉唑、泮托拉唑、兰索拉唑、右旋兰索拉唑、艾普拉唑
促胃肠动力药 主要作用于胃肠道肌间神经丛。主要作用靶点包括乙酰胆碱酯酶、5-HT4受体、D2受体等;具有促进胃肠排空,改善消化不良,抑制恶心、呕吐,胃肠止痛等作用 伊托必利、西尼必利、莫沙必利、曲美布汀、多潘立酮
抗酸剂 中和胃酸,升高胃内容物pH;结合胆汁;覆盖和保护黏膜 铝碳酸镁、磷酸铝凝胶、碳酸氢钠、碳酸钙、氢氧化铝、氢氧化镁、三硅酸镁
H2RA 组胺H2受体的选择性、竞争性拮抗剂,抑制组胺释放产生的酸分泌 西咪替丁、法莫替丁、尼扎替丁、雷尼替丁
TLESR抑制剂 选择性γ-氨基丁酸受体激动剂,减少TLESR的发生 巴氯芬
黏膜保护剂 保护黏膜,促进黏膜愈合 康复新液(溶液剂)、马来酸伊索拉定、瑞巴派特、替普瑞酮、L-谷氨酰胺呱仑酸钠
海藻酸盐 形成泡沫凝胶漂浮于胃内容物上,物理阻断反流进入食管,还可以覆盖和保护黏膜 海藻酸(海藻酸钠)
中成药 健脾和胃,理气消痞,和胃降逆,通利消滞,健脾安神,舒肝解郁等 枳术宽中胶囊、胃苏颗粒、达立通颗粒、加味左金丸、荜铃胃痛颗粒、荆花胃康胶丸、气滞胃痛颗粒、舒肝解郁胶囊、心胃止痛胶囊、香砂平胃颗粒
神经调节剂 主要作用于中枢神经系统,降低内脏高敏感,减轻疼痛和不适感,缓解焦虑和抑郁情绪,改善睡眠;包括三环类、四环类抗抑郁药、苯二氮革类、5_羟色胺再摄取抑制剂、选择性5-羟色胺和去甲肾上腺素再摄取抑制剂、多巴胺再摄取抑制剂、去甲肾上腺素能和特异性5-羟色胺能抗抑郁药等 氟哌噻吨美利曲辛、西酞普兰、度洛西汀、舍曲林、帕罗西汀、舒必利、米氮平、曲唑酮
消化酶 促进食糜消化分解和排空,改善消化不良症状 复方阿嗪米特肠溶片、消化酶
图9 GERD食管外综合征多学科诊治协作流程图
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