小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 烧心
- 反酸
其他诊断因素
- 吞咽困难
- 腹胀/早饱
- 喉炎
- 异物感
- 牙釉质腐蚀
- 口臭
- 消化不良
危险因素
- 烧心或 GORD 家族史
- 老年
- 食管裂孔疝
- 肥胖
- 降低食管下括约肌压力的药物
- 心理应激
- 哮喘
- 非甾体抗炎药 (NSAID)
- 吸烟
- 饮酒
- 经口内镜下肌切开术（Per-oral Endoscopic Myotomy, POEM）
- 饮食因素
- 妊娠
诊断性检查
首要检查
- 质子泵抑制剂试验
需考虑的检查
- 食管胃十二指肠镜检查 (OGD)
- 动态 pH 值监测。
- 食管压力测定
- 联合的阻抗 pH 检测
- 钡餐
- 食管胶囊内镜检查
新兴检查
- 腔内功能性管腔成像探头
治疗流程
初期表现
非妊娠：质子泵抑制剂有效
非妊娠：质子泵抑制剂疗效不佳
妊娠：难治性症状或有并发症的反流病
撰稿人
作者
Marc J. Zuckerman, MD
Professor of Medicine
Chief of Division of Gastroenterology
Texas Tech University Health Sciences Center
El Paso
TX
利益声明
MJZ has been a speaker for Salix Pharmaceuticals, Allergan Pharmaceuticals, and Takeda Pharmaceuticals and has done contract research with Phathom Pharmaceuticals. He is an author of a reference cited in this topic.
Andres F. Carrion, MD
Associate Professor of Clinical Medicine
Division of Gastroenterology and Hepatology
University of Miami
Miami
FL
利益声明
AFC declares that he has no competing interests.
鸣谢
Dr Marc J. Zuckerman and Dr Andres F. Carrion would like to gratefully acknowledge Dr Sheila Feit and Dr Mohamed Othman, previous contributors to this topic.
利益声明
SF declares that she has no competing interests. MO has acted as a consultant for Olympus.
同行评议者
Lars Aabakken, MD
Professor of Medicine
Chief of GI Endoscopy
Rikshospitalet University Hospital
Oslo
Norway
利益声明
LA declares that he has no competing interests.
Lise Lotte Gluud, MD, DMSc
Consultant
Department of Internal Medicine
Copenhagen University Hospital
Hellerup
Denmark
利益声明
LLG declares that she has no competing interests.
Gary W. Falk, MD, MS
Professor of Medicine
Department of Gastroenterology & Hepatology
Center for Swallowing & Esophageal Disorders
Cleveland Clinic
Cleveland
OH
利益声明
GWF has received fees from: AstraZeneca (consultant, speakers bureau, grant support); Takeda (grant support); Pentax (speaker, travel); Wyeth (consultant); and C2 Therapeutics (consultant).
鉴别诊断
- 急性冠脉综合征
- 稳定型心绞痛
- 功能性食管病/功能性烧心
更多 鉴别诊断指南
- 多学会共识会议和指南：胃食管反流病（GERD）的治疗
- AGA 关于质子泵抑制剂处方精简的临床实践更新：专家审评
更多 指南患者教育信息
烧心
GORD：询问医生
更多 患者教育信息
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