2013年美国爱因斯坦医学中心胃食管返流病诊断与管理指南

Gastroesophageal refl ux disease (GERD) is arguably the most common disease encountered by the gastroenterologist. It is equally likely that the primary care providers will fi nd that complaints related to refl ux disease constitute a large proportion of their practice. Th e following guideline will provide an overview of GERD and its presentation, and recommendations for the approach to diagnosis and management of this common and important disease.

Th e document will review the presentations of any risk factors for GERD, the diagnostic modalities and their recommendation for use and recommendations for medical, surgical and endoscopic management including comparative eff ectiveness of diff erent treatments. Extraesophageal symptoms and complications will be addressed as will the evaluation and management of “ refractory” GERD. Th e document will conclude with the potential risks and side eff ects of the main treatments for GERD and their implications for patient management.

Each section of the document will present the key recommendations related to the section topic and a subsequent summary of the evidence supporting those recommendations. A search of OVID Medline, Pubmed and ISI Web of Science was conducted for the years from 1960 – 2011 using the following major search terms and subheadings including “ heartburn ” , “ acid regurgitation ” , “ GERD ” , “ lifestyle interventions ” , “ proton pump inhibitor (PPI)” , “ endoscopic surgery, ” “ extraesophageal symptoms, ” “ Nissen fundoplication, ” and “ GERD complications. ” We used systematic reviews and meta-analyses for each topic when available followed by a review of clinical trials.