摘要
胃食管反流病(GERD)是一种常见的慢性消化系统疾病,严重影响患者生命质量,近年来患病率呈上升趋势,已成为全球重视的医疗问题。抑酸药质子泵抑制剂(PPI)及钾竞争性酸阻滞剂(P-CAB)是目前治疗GERD患者诱导症状缓解和维持治疗的一线药物,其促进黏膜愈合疗效优势确切,但仍有一部分患者症状顽固,反复发作,停药困难,尤其对不典型症状、食管外症状、重叠功能性烧心和反流高敏感的GERD患者抑酸疗效欠佳。长期使用PPI带来的增加胃癌患病风险也备受关注。新型抑酸剂P-CAB问世解决了部分难题,但升级强效抑酸对日间胃内节律的影响较大,也因此逐渐强调适度抑酸。现代医学介入治疗发展较快,为PPI依赖性和难治性GERD提供了新的治疗选择,但其长期疗效存在争议。中医药可通过调节防御因素与侵袭因素间的失衡,多靶点多维度发挥作用,在助力分级降阶梯撤药减、停抑酸药的使用方面疗效优势明确,中西医结合有望成为GERD更优化的临床治疗策略。
Gastroesophageal reflux disease(GERD)is a common chronic digestive disease that seriously affects the quality of life of patients.In recent years,the disease has presented an upward incidence and become a medical problem of global concern.Proton pump inhibitors(PPIs)and potassium-competitive acid blockers(P-CABs)are the first-line acid-suppressing drugs for relieving the symptoms in patients with GERD and demonstrate definite efficacy of promoting mucosal healing.However,there are still some patients with stubborn symptoms,recurrent episodes,and difficult drug withdrawal.Especially for the patients with atypical symptoms,or extra-esophageal symptoms,or overlapping functional heartburn and reflux hypersensitivity,the drugs have limited effect.Moreover,the increased risk of gastric cancer caused by long-term use of PPIs has attracted much attention.The advent of the new acid inhibitor P-CAB has partly solved the problem,while the upgraded potent acid suppression has great impact on the daytime intragastric rhythm.Therefore,moderate acid suppression is gradually emphasized.The rapid development of western interventional therapy has provided a new option for treating the GERD with PPI dependence and the refractory GERD,while its long-term efficacy is still controversial.Traditional Chinese medicine(TCM)plays a role in the treatment of GERD via multiple targets and multiple dimensions by regulating the imbalance between defense factors and invasion factors,which has clear therapeutic effect and can reduce the use of acid suppressants in a graded manner.Furthermore,integrated TCM and western medicine is expected to become an optimized clinical treatment strategy for GERD.
作者
魏秀秀
张北华
尹晓岚
卫裕晨
刘佳丽
唐旭东
WEI Xiuxiu;ZHANG Beihua;YIN Xiaolan;WEI Yuchen;LIU Jiali;TANG Xudong(Graduate School,Beijing University of Chinese Medicine,Beijing 100029,China;iyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China;China Academy of Chinese Medical Sciences,Beijing 100700,China)
出处
《世界中医药》
CAS
2022年第15期2101-2107,共7页
World Chinese Medicine
基金
国家重点研发计划项目(2019YFC1709600)
国家中医药传承创新团队及人才支持计划项目(ZYYCXTD-C-202010)
中国中医科学院科技创新工程项目(CI2021A01001)。
关键词
胃食管反流病
治疗
中西医结合
适度抑酸
分级降阶梯
黏膜愈合
症状缓解
述评
Gastroesophageal reflux disease
Treatment
Integrated traditional Chinese and western medicine
Moderate acid suppression
Reduction in a graded manner
Mucosal healing
Symptom relief
Review
