The latest progress in diagnosis and treatment of gastroesophageal reflux disease by integrated traditional Chinese and Western medicine
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摘要: 胃食管反流病(GERD)的发病率近年来不断上升。目前西药对GERD的治疗手段主要为抑酸剂、促胃肠动力药与黏膜保护剂联用,然而长期使用抑酸剂不良反应大,特别是对于患有难治性胃食管反流病(RGERD)的患者,其症状往往更加严重,且复发率高;GERD也常伴有抑郁、焦虑等临床症状,对患者的日常生活造成了严重的影响。而中医药在治疗GERD方面取得了显著的疗效。因此,在利用西药针对性治疗的同时,结合中医药个体化治疗,可降低GERD复发率,减少对抑酸剂的依赖,从而提高患者的生活质量及临床疗效。本文旨在通过对近年来GERD文献的归纳总结,从中西医结合的角度详细阐述GERD的病因、诊断、治疗,为临床治疗GERD提供有价值的参考,力求减轻GERD患者身心痛苦,提高生活质量。Abstract: The incidence rate of gastroesophageal reflux disease(GERD) has been rising in recent years. At present, the main treatment methods for GERD using Western medicine are the combination of acid suppressants, gastrointestinal-motility promoting drugs, and mucosal protectors. However, the long-term use of acid suppressants has significant adverse reactions, especially for patients with refractory gastroesophageal reflux disease(RGERD), whose symptoms are often more severe and the recurrence rate is high; GERD is often accompanied by clinical symptoms such as depression and anxiety, which have a serious impact on the daily life of patients. Traditional Chinese medicine has achieved significant therapeutic effects in treating GERD. Therefore, while utilizing targeted treatment with Western medicine, individualized treatment with traditional Chinese medicine can often be combined to reduce the recurrence rate of GERD, reduce dependence on acid suppressants, and improve clinical efficacy and patient quality of life. This article aims to summarize and summarize the literature on GERD in recent years and elaborate on the etiology, diagnosis, and treatment of GERD from the perspective of integrated Chinese and Western medicine, providing a valuable reference for clinical treatment of GERD, Striving to alleviate the physical and mental pain of GERD patients and improve their quality of life.
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[1] Fass R. Gastroesophageal reflux disease[J]. N Engl J Med, 2022, 387(13): 1207-1216. doi: 10.1056/NEJMcp2114026
[2] 许乐. 中国老年人胃食管反流病专家共识(2023)解读[J]. 老年医学与保健, 2023, 29(5): 876-879. https://www.cnki.com.cn/Article/CJFDTOTAL-LYBJ202305002.htm
[3] 何聪, 许高凡, 周秉舵, 等. 胃食管反流病相关性胸痛之"食心痛"命名及辨治探微[J]. 中医杂志, 2022, 63(5): 425-429. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202205006.htm
[4] 汤浩, 丁海蛟. 胃食管反流病发病因素研究[J]. 临床军医杂志, 2020, 48(6): 746-747. https://www.cnki.com.cn/Article/CJFDTOTAL-JYGZ202006045.htm
[5] Mehta RS, Nguyen LH, Ma WJ, et al. Association of diet and lifestyle with the risk of gastroesophageal reflux disease symptoms in US women[J]. JAMA Intern Med, 2021, 181(4): 552-554. doi: 10.1001/jamainternmed.2020.7238
[6] 陆喜荣, 杨炜, 张昕琰, 等. 胃食管反流病相关影响因素分析及应对策略[J]. 世界中医药, 2022, 17(15): 2108-2111. https://www.cnki.com.cn/Article/CJFDTOTAL-SJZA202215002.htm
[7] Savarino V, Marabotto E, Zentilin P, et al. Pharmacological management of gastro-esophageal reflux disease: an update of the state-of-the-art[J]. Drug Des Devel Ther, 2021, 15: 1609-1621. doi: 10.2147/DDDT.S306371
[8] Wilkinson JM, Halland M. Esophageal motility disorders[J]. Am Fam Physician, 2020, 102(5): 291-296.
[9] Zheng Z, Shang YX, Wang N, et al. Current advancement on the dynamic mechanism of gastroesophageal reflux disease[J]. Int J Biol Sci, 2021, 17(15): 4154-4164. doi: 10.7150/ijbs.65066
[10] Kurin M, Adil SA, Damjanovska S, et al. Clinical characteristics of patients with ineffective esophageal motility by Chicago classification version 4.0 compared to Chicago classification version 3.0[J]. J Neurogastroenterol Motil, 2023, 29(1): 38-48. doi: 10.5056/jnm21250
[11] 何聪, 周秉舵, 朱生樑, 等. 朱生樑从"结、郁、虚"论治难治性胃食管反流病胸痛经验[J]. 时珍国医国药, 2023, 34(1): 195-197. https://www.cnki.com.cn/Article/CJFDTOTAL-SZGY202301055.htm
[12] 许高凡, 李亚鼎, 何聪, 等. 基于"胃心相关"理论探讨胃食管反流病相关性胸痛中医内涵及发病机制[J]. 北京中医药大学学报, 2023, 46(5): 705-710. https://www.cnki.com.cn/Article/CJFDTOTAL-JZYB202305017.htm
[13] 杨竹青, 郭敏, 王晓鸽, 等. 基于"上焦得通, 津液得下, 胃气因和"探讨胃食管反流病机制[J]. 北京中医药大学学报, 2023, 46(5): 711-716. https://www.cnki.com.cn/Article/CJFDTOTAL-JZYB202305018.htm
[14] 梁笑楠, 战蓉蓉, 张晓岚. 《2020年中国胃食管反流病专家共识》解读[J]. 河北医科大学学报, 2021, 42(8): 869-871, 925. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYX202108002.htm
[15] 肖英莲. 胃食管反流病的诊断[J]. 中国医刊, 2023, 58(3): 236-238. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYI202303002.htm
[16] Delshad SD, Almario CV, Chey WD, et al. Prevalence of gastroesophageal reflux disease and proton pump inhibitor-refractory symptoms[J]. Gastroenterology, 2020, 158(5): 1250-1261. doi: 10.1053/j.gastro.2019.12.014
[17] 李波静, 田涛, 石益海, 等. 107例非糜烂性胃食管反流病24 h pH阻抗监测特点分析[J]. 上海医药, 2021, 42(24): 28-32. https://www.cnki.com.cn/Article/CJFDTOTAL-SYIY202124008.htm
[18] Yadlapati R, Gyawali CP, Pandolfino JE, et al. AGA clinical practice update on the personalized approach to the evaluation and management of GERD: expert review[J]. Clin Gastroenterol Hepatol, 2022, 20(5): 984-994. doi: 10.1016/j.cgh.2022.01.025
[19] 牛涛, 叶婷, 王玉玉, 等. 高分辨率食管测压对胃食管反流病食管运动功能诊断的应用价值[J]. 宁夏医科大学学报, 2021, 43(9): 939-943. https://www.cnki.com.cn/Article/CJFDTOTAL-XNXY202109012.htm
[20] 古岳, 雷鸽, 刘丽娜, 等. 食管高分辨率测压联合24 h pH-阻抗监测在评估胃食管反流病严重程度中的应用[J]. 中国临床医生杂志, 2022, 50(4): 430-434. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLYS202204017.htm
[21] 王琼, 董培雯, 刘丽, 等. 唾液胃蛋白酶水平联合MⅡ-pH预测胃食管反流病患者食管括约肌压力的研究[J]. 现代消化及介入诊疗, 2022, 27(8): 1034-1037. https://www.cnki.com.cn/Article/CJFDTOTAL-XDXH202208023.htm
[22] 彭利, 王竞宇, 郑世成, 等. 胃充盈超声造影与内镜检查对胃食管反流病的诊断价值[J]. 西部医学, 2019, 31(10): 1613-1616. https://www.cnki.com.cn/Article/CJFDTOTAL-XIBU201910031.htm
[23] 吴超, 孙浩然. 食管实时MRI在胃食管反流病中的应用进展[J]. 国际医学放射学杂志, 2022, 45(1): 80-83. https://www.cnki.com.cn/Article/CJFDTOTAL-GWLC202201016.htm
[24] 张北华, 周秉舵, 唐旭东. 胃食管反流病中医诊疗专家共识(2023)[J]. 中医杂志, 2023, 64(18): 1935-1944. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202318019.htm
[25] 沈晨, 陶琳, 张声生, 等. 调肝理脾方治疗伴无效食管动力的胃食管反流病临床观察[J]. 中华中医药杂志, 2022, 37(1): 546-550. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202201112.htm
[26] 吴思霖, 罗芳芳, 王继生, 等. 清热降逆汤治疗胆热犯胃型非糜烂性胃食管反流病效果及对反流改善的作用[J]. 中华中医药学刊, 2022, 40(9): 243-246. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS202209053.htm
[27] 苏坤涵, 刘万里, 杨璐, 等. 基于"治未病"思想构建胃食管反流病健康大数据管理平台[J]. 世界科学技术-中医药现代化, 2020, 22(4): 1068-1074. https://www.cnki.com.cn/Article/CJFDTOTAL-SJKX202004024.htm
[28] 张敏, 王凤云, 唐旭东, 等. 从"治中焦如衡"论治胃食管反流病[J]. 中华中医药杂志, 2020, 35(2): 660-663. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202002039.htm
[29] 刘莉, 谢胜, 刘礼剑, 等. 胃食管反流病患者血浆代谢组学研究及临床观察[J]. 广西大学学报(自然科学版), 2022, 47(1): 254-261. https://www.cnki.com.cn/Article/CJFDTOTAL-GXKZ202201027.htm
[30] Gyawali CP, Kahrilas PJ, Savarino E, et al. Modern diagnosis of GERD: the Lyon consensus[J]. Gut, 2018, 67(7): 1351-1362. doi: 10.1136/gutjnl-2017-314722
[31] 陈嘉韵, 李安安, 吕朝晖, 等. 长期服用质子泵抑制剂对骨密度和骨代谢影响的Meta分析[J]. 中国组织工程研究, 2021, 25(17): 2775-2780. https://www.cnki.com.cn/Article/CJFDTOTAL-XDKF202117026.htm
[32] Gommers LMM, Hoenderop JGJ, de Baaij JHF. Mechanisms of proton pump inhibitor-induced hypomagnesemia[J]Acta Physiol(Oxf), 2022, 235(4): e13846. doi: 10.1111/apha.13846
[33] Kim GH. Proton pump inhibitor-related gastric mucosal changes[J]. Gut Liver, 2021, 15(5): 646-652. doi: 10.5009/gnl20036
[34] Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease[J]. Am J Gastroenterol, 2022, 117(1): 27-56. doi: 10.14309/ajg.0000000000001538
[35] Talley NJ, Zand Irani M. Optimal management of severe symptomatic gastroesophageal reflux disease[J]. J Intern Med, 2021, 289(2): 162-178. doi: 10.1111/joim.13148
[36] Frazzoni M, Piccoli M, Conigliaro R, et al. Laparoscopic fundoplication for gastroesophageal reflux disease[J]. World J Gastroenterol, 2014, 20(39): 14272-14279. doi: 10.3748/wjg.v20.i39.14272
[37] Ghanem OM, Ghazi R, Abdul Razzak F, et al. Turnkey algorithmic approach for the evaluation of gastroesophageal reflux disease after bariatric surgery[J]. Gastroenterol Rep, 2023, 11: goad028.
[38] Bonavina L, Fisichella PM, Gavini S, et al. Clinical course of gastroesophageal reflux disease and impact of treatment in symptomatic young patients[J]. Ann N Y Acad Sci, 2020, 1481(1): 117-126. doi: 10.1111/nyas.14350
[39] Ota K, Takeuchi T, Higuchi K, et al. Frontiers in endoscopic treatment for gastroesophageal reflux disease[J]. Digestion, 2024, 105(1): 5-10. doi: 10.1159/000533200
[40] Li ZH, Li YL, Wu Y, et al. Endoscopic tightening of the cardia mucosa in gastroesophageal reflux disease: a case series of 120 patients up to 1-year follow-up[J]. J Clin Transl Res, 2022, 8(2): 147-151.
[41] 李振华, 张勤生, 李明彦, 等. 内镜下贲门松弛紧缩术治疗胃食管反流病23例[J]. 世界最新医学信息文摘, 2022, 22(78): 52-56. https://cpfd.cnki.com.cn/Article/CPFDTOTAL-ZGZP201907001064.htm
[42] Ota K, Takeuchi T, Kojima Y, et al. Outcomes of endoscopic submucosal dissection for gastroesophageal reflux disease(ESD-G)for medication-refractory gastroesophageal reflux disease: 35 cases underwent ESD-G including 15 cases followed more than 5 years[J]. BMC Gastroenterol, 2021, 21(1): 432. doi: 10.1186/s12876-021-02022-x
[43] 常越, 陈希, 田永, 等. 应用内镜下贲门部套扎紧缩成形术治疗胃食管反流病的临床疗效[J]. 中国内镜杂志, 2020, 26(9): 19-24. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGNJ202009005.htm
[44] 张勤生, 吴明阳. 国医大师张磊运用达郁汤治疗慢性萎缩性胃炎经验[J]. 中医研究, 2021, 34(11): 72-74. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYJ202111021.htm
[45] 朱淑云. 半夏泻心汤加味方配合针灸治疗胃食管反流病寒热错杂型的疗效及对中医证候、生活质量的影响[J]. 中国全科医学, 2019, 22(S2): 177-179. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX2019S2064.htm
[46] 蔡开莉, 周文静, 董洁群, 等. 龙祖宏教授擅用"和法"治疗胃食管反流病[J]. 时珍国医国药, 2020, 31(6): 1494-1495. https://www.cnki.com.cn/Article/CJFDTOTAL-SZGY202006074.htm
[47] 车慧, 卞立群, 王凤云, 等. 健脾化湿、清热和胃治疗脾虚湿热型胃食管反流病[J]. 中医杂志, 2019, 60(24): 2143-2145. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ201924021.htm
[48] 党志博, 罗磊, 李梦阁, 等. 理气降逆法中药复方治疗胃食管反流病的临床疗效及对复发率的影响的Meta分析[J]. 中医杂志, 2023, 64(12): 1225-1234. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202312008.htm
[49] 倪晶, 许异川, 火龙, 等. 左金丸治疗肝胃郁热证胃食管反流病的随机双盲安慰剂对照临床研究[J]. 中国中西医结合消化杂志, 2023, 31(12): 955-960. https://zxyxh.whuhzzs.com/article/doi/10.3969/j.issn.1671-038X.2023.12.09
[50] 王杰, 孙永顺. 柴芍通降方治疗肝胃不和证非糜烂性反流病的临床疗效观察[J]. 中国中西医结合消化杂志, 2023, 31(7): 545-551. https://zxyxh.whuhzzs.com/article/doi/10.3969/j.issn.1671-038X.2023.07.12
[51] Xu LY, Yu BY, Cen LS. New treatment for gastroesophageal reflux disease: Traditional medicine, Xiaochaihu decoction[J]. World J Gastroenterol, 2022, 28(11): 1184-1186. doi: 10.3748/wjg.v28.i11.1184
[52] 潘炜炳, 黄雪, 张陪, 等. 白兴华教授诊治胃食管反流病理念及经验[J]. 中国针灸, 2020, 40(8): 868-872. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE202008025.htm
[53] 孙千惠, 李婷婷, 黄敏婷, 等. 基于数据挖掘技术探究国内针刺治疗胃食管反流病的选穴规律[J]. 中国针灸, 2020, 40(12): 1374-1378. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE202012031.htm
[54] 齐梅, 周悦, 张梦圆, 等. 疏肝和胃方联合伏诺拉生治疗气郁痰阻型难治性胃食管反流病的临床疗效[J]. 中国实验方剂学杂志, 2023, 29(24): 146-154. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX202324016.htm
[55] 张辉凯, 罗宏伟, 张亚静. 半夏厚朴汤加减联合奥美拉唑对痰气郁结型胃食管反流患者的临床疗效[J]. 中成药, 2021, 43(11): 3019-3023. https://www.cnki.com.cn/Article/CJFDTOTAL-ZCYA202111015.htm
[56] 黄飞霞, 邓明, 翁庚民. 栀子厚朴汤、栀子豆豉汤合乌梅丸化裁治疗难治性胃食管反流病的临床观察[J]. 中华中医药学刊, 2022, 40(3): 216-219. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS202203048.htm
[57] 张泰, 张北华, 马祥雪, 等. 中西医结合治疗难治性胃食管反流病的优势[J]. 中国中西医结合杂志, 2022, 42(9): 1124-1131. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZXJ202209014.htm
[58] 王萍, 王凤云, 蓝宇, 等. 中医药临床优势病种探讨——胃食管反流病[J]. 中国实验方剂学杂志, 2023, 29(12): 199-208. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX202312024.htm
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