内镜抗反流黏膜切除术治疗难治性胃食管反流病一例

Treatment of refractory gastroesophageal reflux disease by endoscopic anti-reflux mucosa resection—A case report

摘要:

胃食管反流病(GERD)是指胃或十二指肠内容物反流至食管引起不适症状和/或并发症的一种疾病，以烧心和反流为典型表现。大多数糜烂性胃食管反流病患者的病变程度为轻度（洛杉矶分级 A 级患者占 50-90%），因此，目前对GERD的治疗主要依靠质子泵抑制剂（PPI）。但仍有一部分患者PPI治疗疗效甚微。目前亚太的共识认为：在常规PPI剂量治疗至少 8 周反流症状仍无缓解的 GERD 可以定义难治性胃食管反流病（Refractory GERD，RGERD）。对于RGERD的治疗，最近内镜下出现了一种新的治疗方法——抗反流黏膜切除术(ARMS)，初步报导可以有效地重塑贲门抗反流屏障，改善患者症状。在这篇报告中，我们将介绍国内首例通过抗反流黏膜切除术(ARMS)治疗难治性胃食管反流病的病例。

Abstract:

Gastroesophageal reflux disease (GERD) refers to a disease in which the gastric or duodenal contents are refluxed to the esophagus to cause discomfort and / or complications, with heartburn and reflux as a typical manifestation. Most patients with erosive gastroesophageal reflux disease are mild (Los Angeles grade A patients 50-90%), so the current treatment of GERD mainly relys on proton pump inhibitors (PPI). But still a part of the patients have little effect on PPI. At present, the Asia-Pacific consensus on GERD defines refractory gastroesophageal reflux disease (Refractory GERD, RGERD) as patients fail conventional PPI dose regimen for at least 8 weeks. For the treatment of RGERD, a new treatment, anti-reflux mucosal resection (ARMS), has recently been published, which can effectively rebuild the cardia anti-reflux barrier and improve patients’ symptoms. In this report, we will introduce the first domestic cases of ARMS in the treatment of RGERD.