酸相关疾病的现代诊断与管理。

文献信息

中文摘要

酸相关疾病是胃肠病患者中最常见且花费最高的疾病之一。这些患者的诊疗已发生重大演变。本综述总结了部分最常见酸相关疾病的重要进展，包括胃食管反流病（GERD）和咽喉反流（LPR）、消化性溃疡病（PUD）和幽门螺杆菌（Hp）感染，以及巴雷特食管（BE）。重大技术和概念突破，包括多日pH监测、BE的内镜下根除治疗（EET），以及GERD和LPR的现代诊断范式，简化了患者识别并简化了管理。鉴于抗菌药物耐药性日益增加，Hp感染及相关PUD的最佳管理已发生变化。本文还考虑了钾竞争性酸阻滞剂（P-CABs）在酸相关疾病患者诊疗中迅速演变的位置。患者诊疗的核心主题包括从经验性治疗转向诊断算法，这些算法既确定疾病的原因，也确定治疗所需的程度和持续时间。此外，诊断和治疗正日益基于症状特征和来自日益复杂的诊断手段库的辅助诊断数据进行个体化。治疗算法展示了上述许多技术在酸相关疾病患者诊疗中的适当使用。

英文摘要

Acid-related disorders are among the most common and costly suffered by gastroenterology patients. Substantial evolution has occurred in the care of these patients. This review summarizes major advances in some of the most common acid-related disorders, including gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR), peptic ulcer disease (PUD) and Helicobacter pylori (Hp) infection, and Barrett's esophagus (BE). Major technical and conceptual breakthroughs, including multiday pH measurement, endoscopic eradication therapy (EET) for BE, and modern diagnostic paradigms for GERD and LPR have streamlined patient identification and simplified management. Given increasing antimicrobial resistance, optimal management of Hp infection and related PUD has changed. The rapidly-evolving place of potassium-competitive acid blockers (P-CABs) in the care of patients with acid-related disorders is considered. Central themes in patient care include a move away from empiric therapy and toward diagnostic algorithms that define both the cause of the condition and the degree and duration of therapy necessary to treat it. Also, diagnosis and therapy are increasingly being personalized based on symptom profile and adjunct diagnostic data from an increasingly complex armamentarium of modalities. Therapeutic algorithms demonstrate the appropriate use of many of the technologies noted above in the care of patients with acid-related disorders.