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难治性胃食管反流病RGERDDefinitionofRGERDPPIfailedinEachoftheGastrooesophagealRefluxDisease(GERD)Groups30%NERDfailtoPPItreatmentNERD-acid,visceralsensitivityPotentialcausesofPPIrefractorinessinGERD7WeaklyAcidRefluxPoorCompliancewithPPITreatmentNocturnalAcidBreakthroughDilatedintercellularspacesBileRefluxPsychologicalComorbiditiesNewMechanismProteaseactivatedreceptor2(PAR2)ProinflammatoryandNeuroinflammatoryAspectsEsophagealEosinophiliaErosiveesophagitismayberelatedtosmallintestinalbacterialovergrowthScandinavianJournalofGastroenterology.2012DiagnosistestsUpperGastrointestinalEndoscopyAnewmethodinthediagnosisofrefluxesophagitis:confocallaserendomicroscopy.GIE.2012共聚焦激光显微内镜诊断NERDNERDdiagnosedbyCLE-DilatedDICEsophagealpHmonitoringallowthequantificationofesophagealacidexposureandtheassessmentofthetemporalrelationshipbetweensymptomsandacidrefluxevents.PHmonitoringcanbeperformedoffPPItotestiftheinitialdiagnosiswascorrect(i.e.,heartburnwasduetoacidreflux)oronPPItotestwhetherthesymptomsareduetoresidualacidreflux.Ambulatory24hEsophagealpHMonitoring-GraphsTreamentofRGERDGERDandPPINewPPIsHistamine2receptorantagonist(H2RA)PromotilitytherapyTransientloweresophagealsphincterrelaxation(TLESR)reducersGastroesophagealrefluxdisease-fromrefluxepisodestomucosalinflammation.Nat.Rev.Gastroenterol.Hepatol.2012AntirefluxSurgeryEndoscopictherapyLINXrefluxmanagementsystemManagementalgorithmofGERDpatientwhofailedPPIoncedailyThankyouforyourattention!!
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