英文课件难治性胃食管反流病ppt
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Gut,2004,53:1024-1031
Esophageal Hypersensitivity
Potential factors contributing to the spectrum of reflux perception in patients with GERD
Esophageal receptor upregulation and/ or enhanced signaling
Remains an area of controversy
PPI failed in Each of the Gastrooesophageal Reflux Disease (GERD) Groups
GERD
NERD 60-70% EE 20-30% Barrett′s oesophagus 6-10%
at bedtime as-needed
28% 4%
Aliment Pharmacol Ther 2006;23:1473–7
—Richter JE Natl Clin Gastroenterol 2007;4:658
Others suggest that lack of satisfactory symptomatic
response to PPI once a day is sufficient to consider patients as PPI failures.
此ppt下载后可自行编辑
难治性胃食管反流病
Refractory Gastroesophageal reflux disease
Definition of RGERD
RGERD:Patients who are unresponsive to 4-8 weeks'
treatment with PPIs twice daily or esophageal injury caused by RE can’t to be healing.
Any attempt to narrow the definition of refractory GERD
might exclude many true sufferers.
——Hershcovici T et al. Best Practice& Research Clinical Gastroenterology 2010 (24)923-936
NAB
Poor compliance with PPI treatment
Mechanism
Dilated intercellular spaces
Gastroparesis
Esophageal hypersensitivity
DGER
Weakly Acid Reflux
The prevalence of weakly acidic reflux in refractory GERD is
30-40%. When the esophageal pH falls by ≥ 1 unit, but remains ＞4, it is considered “weakly acidic reflux”.
• Esophageal distension
• Persistent impaired mucosal integrity • Esophageal hypersensitivity
Gastroparesis, concomitant in 25% of patients with gastroesophageal reflux disease (GERD), has been shown to improve after Nissen fundoplication.
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES ，2008，22 （11） 2440-2444
Failure on PPI qd 40-50%
Failure on PPI qd 6-15%
Failure on PPI qd ቤተ መጻሕፍቲ ባይዱ0%
——Fass et al. Aliment Pharmacol Ther 2005; 22(2):79-94.
30%NERD fail to PPI treatment
NERD-acid,visceral sensitivity
Potential causes of PPI refractoriness in GERD
Neurogastroenterol Motil (2012) 24, 697–704
Weakly acid reflux Psychological
Poor Compliance with PPI Treatment
Compliance to treatment and proper dosing are important. Timing and frequency of dosing are critical for maximum
Physiological stressors, sensitization of spinal sensory neurons
AM J Gastroenterol ,2012,107, 8-15.
Gastroparesis
Delayed gastric emptying (gastroparesis) may be a factor associated with severe reflux, dyspepsia, or both.
efficacy of the medication.
PPI dosing situation in 100 patients with persistent GERD symptoms Patients dosed Proper dosing timing optimally the PPIs(%) Patients dosed suboptimally the PPIs(%) >60 min before meals after meals 46% 39% 30%
Esophageal Hypersensitivity
Potential factors contributing to the spectrum of reflux perception in patients with GERD
Esophageal receptor upregulation and/ or enhanced signaling
Remains an area of controversy
PPI failed in Each of the Gastrooesophageal Reflux Disease (GERD) Groups
GERD
NERD 60-70% EE 20-30% Barrett′s oesophagus 6-10%
at bedtime as-needed
28% 4%
Aliment Pharmacol Ther 2006;23:1473–7
—Richter JE Natl Clin Gastroenterol 2007;4:658
Others suggest that lack of satisfactory symptomatic
response to PPI once a day is sufficient to consider patients as PPI failures.
此ppt下载后可自行编辑
难治性胃食管反流病
Refractory Gastroesophageal reflux disease
Definition of RGERD
RGERD:Patients who are unresponsive to 4-8 weeks'
treatment with PPIs twice daily or esophageal injury caused by RE can’t to be healing.
Any attempt to narrow the definition of refractory GERD
might exclude many true sufferers.
——Hershcovici T et al. Best Practice& Research Clinical Gastroenterology 2010 (24)923-936
NAB
Poor compliance with PPI treatment
Mechanism
Dilated intercellular spaces
Gastroparesis
Esophageal hypersensitivity
DGER
Weakly Acid Reflux
The prevalence of weakly acidic reflux in refractory GERD is
30-40%. When the esophageal pH falls by ≥ 1 unit, but remains ＞4, it is considered “weakly acidic reflux”.
• Esophageal distension
• Persistent impaired mucosal integrity • Esophageal hypersensitivity
Gastroparesis, concomitant in 25% of patients with gastroesophageal reflux disease (GERD), has been shown to improve after Nissen fundoplication.
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES ，2008，22 （11） 2440-2444
Failure on PPI qd 40-50%
Failure on PPI qd 6-15%
Failure on PPI qd ቤተ መጻሕፍቲ ባይዱ0%
——Fass et al. Aliment Pharmacol Ther 2005; 22(2):79-94.
30%NERD fail to PPI treatment
NERD-acid,visceral sensitivity
Potential causes of PPI refractoriness in GERD
Neurogastroenterol Motil (2012) 24, 697–704
Weakly acid reflux Psychological
Poor Compliance with PPI Treatment
Compliance to treatment and proper dosing are important. Timing and frequency of dosing are critical for maximum
Physiological stressors, sensitization of spinal sensory neurons
AM J Gastroenterol ,2012,107, 8-15.
Gastroparesis
Delayed gastric emptying (gastroparesis) may be a factor associated with severe reflux, dyspepsia, or both.
efficacy of the medication.
PPI dosing situation in 100 patients with persistent GERD symptoms Patients dosed Proper dosing timing optimally the PPIs(%) Patients dosed suboptimally the PPIs(%) >60 min before meals after meals 46% 39% 30%