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背景与目的:自从2004年亚太地区胃食管反流病(GERD)共识发表以来,更多关于GERD流行病学和处理的文献资料相继出现。有必要对这些资料进行循证综述,对共识作出更新。方法:由多学科专家组应用德尔菲(Delphi)法制定共识条文,提呈相关资料,并对证据质量、推荐力度和共识水平进行分级。结果:亚洲GERD发生率日益增加。其危险因素包括老年、男性、种族、家族史、社会经济地位高、体重指数增加和吸烟。对于有典型症状而无报警症状的患者,对质子泵抑制剂(PPI)试验有症状应答具有诊断意义。如PPI试验失败,停止治疗后pH监测结果阴性可排除GERD。窄带成像、胶囊内镜检查和无线pH监测的作用尚未明确。亚洲诊断策略的制定须考虑到并存的胃癌和消化性溃疡。减轻体质量和抬高床头可改善反流症状。PPIs是最有效的内科治疗手段。对于非糜烂性反流病(NERD)患者,按需治疗较为适宜。有慢性咳嗽、喉炎和典型GERD症状的患者在排除非GERD病因后,应予PPI每天两次治疗。如有经验丰富的外科医师,GERD患者可行胃底折叠术。除临床试验外,GERD不应采用内镜治疗。结论:新的诊断方法和内镜治疗的作用有待进一步研究阐明。亚洲GERD诊断策略的制定须考虑到并存的胃癌和消化性溃疡。PPIs仍为治疗的基石。
Background and Objectives Since the publication of the consensus on gastroesophageal reflux disease (GERD) in the Asia-Pacific region in 2004, more literature has emerged on the epidemiology and treatment of GERD. There is a need for an evidence-based review of these materials to update the consensus. Methods: The multidisciplinary group of experts applied the Delphi method to establish the consensus clause, presented relevant information, and rated the quality of evidence, recommended strength and consensus level. Results: The incidence of GERD in Asia is increasing. Risk factors include age, men, race, family history, high socioeconomic status, increased body mass index and smoking. Symptomatic response to proton pump inhibitor (PPI) tests is diagnostic for patients with typical symptoms and no alarm symptoms. Such as PPI test failure, stop the treatment of negative pH monitoring results can rule out GERD. The role of narrowband imaging, capsule endoscopy and wireless pH monitoring is not yet clear. The development of diagnostic strategies in Asia should take into account the coexistence of gastric cancer and peptic ulcer. Reduce body mass and raise the bed can improve reflux symptoms. PPIs is the most effective medical treatment. On non-erosive reflux disease (NERD) patients, on-demand treatment is more appropriate. Patients with chronic cough, laryngitis and typical GERD symptoms should be treated twice daily with PPI after excluding the cause of non-GERD. GERD patients underwent fundoplication should experienced surgeons. In addition to clinical trials, GERD should not be endoscopic treatment. Conclusion: The new diagnostic methods and the role of endoscopic treatment need further elucidation. The development of diagnostic strategies for GERD in Asia must take into account the coexistence of gastric cancer and peptic ulcer. PPIs are still the cornerstone of treatment.