内镜治疗
迄今已经尝试了多种操作方法。目前使用的两种方法是内镜射频消融术和经口无切口胃底折叠术 (transoral incisionless fundoplication, TIF)。[24]Muthusamy VR, Lightdale JR, Acosta RD, et al; ASGE Standards of Practice Committee. The role of endoscopy in the management of GERD. Gastrointest Endosc. 2015;81(6):1305-10.http://www.giejournal.org/article/S0016-5107(15)00147-9/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/25863867?tool=bestpractice.com 目前没有足够的证据来支持这些方法。[73]Chen D, Barber C, McLoughlin P, et al. Systematic review of endoscopic treatments for gastro-oesophageal reflux disease. Br J Surg. 2009 Feb;96(2):128-36.http://www.ncbi.nlm.nih.gov/pubmed/19160349?tool=bestpractice.com[74]Huang X, Chen S, Zhao H, et al. Efficacy of transoral incisionless fundoplication (TIF) for the treatment of GERD: a systematic review with meta-analysis. Surg Endosc. 2017 Mar;31(3):1032-44.http://www.ncbi.nlm.nih.gov/pubmed/27495332?tool=bestpractice.com[75]ASGE Technology Committee; Thosani N, Goodman A, Manfredi M, et al. Endoscopic anti-reflux devices (with videos). Gastrointest Endosc. 2017 Dec;86(6):931-48.http://www.ncbi.nlm.nih.gov/pubmed/29054276?tool=bestpractice.com目前仍没有明确的适应证,而且在安全性和疗效、患者选择以及疗效持久性方面也有担忧。[76]Zagol B, Mikami D. Advances in transoral fundoplication for oesophageal reflux. Dig Liver Dis. 2011 May;43(5):361-4.http://www.ncbi.nlm.nih.gov/pubmed/21382755?tool=bestpractice.com 一些试验已经证明经口无切口胃底折叠术是安全的,而且能够改善症状。[77]Bell RC, Mavrelis PG, Barnes WE, et al. A prospective registry of patients with chronic gastroesophageal reflux disease receiving transoral incisionless fundoplication. J Am Coll Surg 2012 Dec;215(6):794-809.http://www.ncbi.nlm.nih.gov/pubmed/22939637?tool=bestpractice.com[78]Witteman BP, Conchillo JM, Rinsma NF, et al. Randomized controlled trial of transoral incisionless fundoplication vs. proton pump inhibitors for treatment of gastroesophageal reflux disease. Am J Gastroenterol. 2015 Apr;110(4):531-42.http://www.ncbi.nlm.nih.gov/pubmed/25823768?tool=bestpractice.com[79]Hunter JG, Kahrilas PJ, Bell RC, et al. Efficacy of transoral fundoplication vs omeprazole for treatment of regurgitation in a randomized controlled trial. Gastroenterology. 2015 Feb;148(2):324-33http://www.gastrojournal.org/article/S0016-5085(14)01208-6/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/25448925?tool=bestpractice.com 有人建议,在与非复杂性 GORD 特定患者仔细讨论潜在不良反应、益处和其他可用治疗方案后,可考虑进行内镜抗反流治疗。[24]Muthusamy VR, Lightdale JR, Acosta RD, et al; ASGE Standards of Practice Committee. The role of endoscopy in the management of GERD. Gastrointest Endosc. 2015;81(6):1305-10.http://www.giejournal.org/article/S0016-5107(15)00147-9/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/25863867?tool=bestpractice.com
肥胖和胃食管反流病患者的减肥手术
患有胃食管反流病的肥胖患者可能符合减肥手术的标准,可以考虑通过减肥手术来治疗肥胖。[1]Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013 Mar;108(3):308-28.http://gi.org/guideline/diagnosis-and-managemen-of-gastroesophageal-reflux-disease/http://www.ncbi.nlm.nih.gov/pubmed/23419381?tool=bestpractice.com GORD 肥胖患者可能从减肥手术而非抗反流手术中获益。[71]Fuchs KH, Babic B, Breithaupt W, et al. EAES recommendations for the management of gastroesophageal reflux disease. Surg Endosc. 2014;28:1753-1773.http://www.eaes.eu/getmedia/3c9ae55d-8d98-4678-940e-f236883ad297/Fuchs-EAES-recommendations-GERC-Surg-Endosc-2014.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/24789125?tool=bestpractice.com 尚不明确基于 BMI 的适应证和要使用的最佳手术方式;但是与其他减重手术相比,roux-en-Y 形旁路吻合术似乎能更好地控制反流症状(高达 70%)。[80]Madalosso CA, Gurski RR, Callegari-Jacques SM, et al. The impact of gastric bypass on gastroesophageal reflux disease in patients with morbid obesity: a prospective study based on the Montreal Consensus. Ann Surg. 2010 Feb;251(2):244-8.http://www.ncbi.nlm.nih.gov/pubmed/20010088?tool=bestpractice.com