尽管使用质子抑制剂治疗,但患有不耐逆流症症状的患者的管理:基于证据的共识陈述
David Armstrong1, A Pali Hungin2, Peter J Kahrilas3
1Division of Gastroenterology & Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Alimentary pharmacology & therapeutics
|December 31, 2024
概括
尽管有PPI,但持续的GERD症状很常见. 这种共识指导临床医生通过个性化策略和客观测试来管理耐药性反流性症状 (rRLS).
科学领域:
- 胃肠病学 胃肠病学
- 临床实践指南 临床实践指南
- 耐火GERD管理 耐火GERD管理
背景情况:
- 许多患有胃食道逆流性疾病 (GERD) 的患者即使使用质子抑制剂 (PPI) 治疗,也会出现持续的症状.
- 耐药性反流性症状 (rRLS) 是一个重大的临床挑战.
研究的目的:
- 为临床医生建立基于证据的陈述,管理具有耐火性反流性症状 (rRLS) 或耐火性GERD的患者.
- 为指导持久性GERD症状患者的诊断和治疗优化.
主要方法:
- 由国际食道炎分类工作组开发.
- 利用系统的文献评论和GRADE方法进行证据评分.
- 专注于关于管理PPI耐火性rRLS的PICO问题.
主要成果:
- 在17个rRLS诊断和管理陈述中的13个达成共识.
- 建议的诊断策略包括内镜检查,门诊逆流检测和食道计量.
- 建议不要增加PPI剂量超过每天两次使用的8周;建议酸盐或抗酸治疗.
结论:
- 对rRLS的个性化管理至关重要,包括对诊断测试的共享决策.
- 在考虑抗反流程序之前,需要客观确认GERD.
- 治疗优化应基于确诊的GERD诊断.
相关概念视频
Gastroesophageal Reflux Disease II: Clinical Features and Management
54
Gastroesophageal reflux disease, or GERD, is a persistent medical condition that affects many individuals worldwide. Its clinical manifestations can vary greatly, making diagnosis and management challenging for healthcare professionals. The following is a comprehensive overview of the clinical manifestations, assessment, and management strategies for GERD.
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...
54
Peptic Ulcer Disease IV: Management
72
Medical treatment strategies for peptic ulcers encompass various methods. The primary goal of treatment is to diminish gastric acidity and strengthen mucosal defense mechanisms.
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current...
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current...
72
Barrett Esophagus-II: Clinical Manifestations and Management
103
Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
103
Treating Helicobacter pylori in Peptic Ulcers: Antimicrobial Therapy
326
Helicobacter pylori, a resilient gram-negative bacterium, can thrive in the stomach's harsh, acidic environment. Infection with H. pylori leads to a cascade of events within the stomach lining. One of the critical disruptions caused by this bacterium is the interference with somatostatin production, a hormone responsible for regulating acid secretion. This interference tips the balance, escalating acid secretion and diminishing bicarbonate levels. This imbalance compromises the defensive...
326
Esophageal Strictures-II: Clinical Features and Management
46
Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
46
Acid Suppressive Drugs for Peptic Ulcer Disease: Proton Pump Inhibitors
357
Peptic ulcers, often induced by H. pylori infections or NSAID usage, arise from disruptions in the delicate balance of gastric acid production. Peptic ulcers stem from heightened gastric acid levels due to H. pylori infections or NSAID use. The protective mucus layer diminishes in the presence of these factors, allowing gastric acid to erode the stomach lining and form ulcers.
Gastric acid, a potent cocktail of hydrogen and chloride ions, is produced in specialized parietal cells within the...
Gastric acid, a potent cocktail of hydrogen and chloride ions, is produced in specialized parietal cells within the...
357


