gastroesophageal reflux disease is a common disease, frequently-occurring disease, and the incidence increases gradually, the typical symptoms of heartburn and reflux.on outpatient service often has the patient complained of chinese traditional medicine western medicine take a lot of, adhere to the treatment for a long time, but the symptoms are always not satisfied control, seriously affected the work, life and mood, this is vacant.so, when the case, what should we do?the following, i will in the diagnosis and treatment of the disease status quo do a simple introduction, hope i can be a guide for everyone to see a doctor.
clear diagnosis is the primary
gastroesophageal reflux disease include reflux esophagitis, non erosive reflux disease, barrett esophagus and asymptomatic reflux several ways.in terms of diagnosis, mainly by western medicine examination to determine.
common symptoms of two groups of
in the digestive tract symptoms, the most common symptoms is heartburn and anti acid, also can have retrosternal pain, belching, nausea, early enough, abdominal distension or dull pain;extraesophageal symptoms should not be ignored, such as often pharyngeal adverse, voice hoarse, nose pharynx ministry unwell, chronic cough, and asthma symptoms, but the pharyngitis, laryngitis, sinus problems, cough and asthma treatment, the symptoms can not control.
when you have the above symptoms, should think of gastroesophageal reflux disease is possible, as soon as possible to digestive internal medicine doctor, corresponding to accept inspections, regular treatment.
inspection methods commonly used
endoscopy is judge whether there is a reflux esophagitis and barrett's esophagus and reliable method.the severity of the can of reflux esophagitis.endoscopic can also be to biopsy specimens of esophageal mucosa to do pathological examination, understand the mucosa pathological status, presence of barrett esophagus and precancerous lesions.
with conventional optical endoscopy can see under typical of reflux esophagitis, esophageal dentate line up, esophageal mucosa damage, serious ulcers can be in the esophageal mucosa lesions seen, narrow or bleeding) and"barrett esophagus.magnifying endoscopy and laser confocal endoscopy can find conventional endoscopy can find esophageal mucosa slight change, not missing.
esophageal pressure is getting to know the esophageal body motion state and the state of the upper and lower esophagus smooth muscle function is the most reliable standard.through the inspection, we can know whether patients with gastroesophageal reflux disease at dynamic anomaly, provide a basis for drug use.
esophageal dynamic ph test is to know whether there is a really acid reflux, clear characteristics of acid reflux means necessary.through this test can be confirmed that the so-called"no reflux symptoms", and with the exception of"functional"heartburn, to guide clinicians for drug use.
western medicine is the main
western medicine thinks that this disease is essentially a stomach esophagus movement disorder.its main pathogenesis link includes the structure and function of esophageal reflux resistance ability to remove to abate, esophageal reflux, and weakening of gastric emptying function.mainly for pathogenesis treatment, to change your lifestyle, acid suppression, promote power medicine and surgery as the main principle, clinical curative effect affirmation.common methods are as follows.based treatment
avoid drinking coffee, strong tea, and hot and sour greasy food, reduce weight, raise the head of a bed during sleep at night, keep optimistic attitude, maintain normal sleep patterns of diet.these symptoms for control is important;symptoms of sporadic, through the above control can no longer recurrence.
acid secretion medicine suppression is the preferred treatment of the disease.at present the main use of proton pump inhibitors, such as omeprazole, rabeprazole etc, la sola, panxi tora azole, esso beauty.medication commonly 4~ 8 weeks, then take into consideration the changes in medication, medication with symptoms temporarily, at ordinary times is not medicine.think at present, the drug good long-term medication safety.
to promote power of reflux drugs alone or with proton pump inhibitors for the treatment of the disease effectively.drugs are ding lin, moser will benefit, she will benefit as well as d bromide.
mucosa protectant as sucralfate, can not only directly cover protection of esophageal mucosa, and to improve its defense capabilities, promote restoration of the damaged mucosa, relieve clinical symptoms.
antianxiety drugs for conventional treatment is invalid, or merging obvious psychological and mental disorders, can consider to add with these drugs.
operation method is already very mature at present.clinical studies have demonstrated that the long-term efficacy of surgery and the on-demand treatment efficacy of proton pump inhibitors;at the same time, taking proton pump inhibitors, the result is bad, anti reflux operation curative effect is not significant.so general that taking proton pump inhibitors are effective, but because the drug allergy or not long-term medication, surgery can be considered.
the doctor of traditional chinese medicine treatment of distinctive
western medicine understanding of the disease is already very deep, its inspection diagnosis and treatment measures is also very standard, curative effect affirmation, and even can be regarded as standard treatment.even so, there are still some problems.one is internal medicine medications short-term curative effect affirmation, but many patients need long-term medication, the resulting risk difficult to assess;even if the surgery is also the possibility of recurrence.second, even if short-term treatment, some patients also invalid, some symptoms aggravate after taking drugs.this suggests that western medicine only for esophageal local physiological pathology and anatomy changes and treatment, has its own one-sidedness.
the disease before the reform and opening up is not common, is a significant increase in incidence in recent 20 years, close to the western developed countries.investigate its reason, and the reform of china's cultural tradition.on the one hand, social pressure, life rhythm too fast, make people mental obvious deviation, cannot be handled calmly and daily affairs;on the other hand, western diet structure, routine audio, too comfortable material life, and make people healthy condition, especially the adjustment ability decreased obviously.combination, may result in gastroesophageal reflux disease is the main reason for the increased incidence.
clinical observation also confirmed that all patients complained of mood swings, diet is not the cause of irregular section and life;overnutrition in most patients, work life stress, the mood is very anxious, there are quite a part of the patient is in a state of anxiety depression;and after life guidance to its, after living in patients with positive adjustment diet mentality, symptoms significantly reduce soon, even control, many patients rarely again hair from now on.
unlike western medicine, traditional chinese medicine) appeal, in addition to the emphasis on primary symptom heartburn anti acid asked carefully, people pay more attention to the systemic symptom of pulse and tongue diagnosis.clinical observation found that gastroesophageal reflux disease with heartburn anti acid as the primary symptom, but is often accompanied by obvious systemic symptom, such as loss of appetite, eat less, insomnia, mental emotional psychological disorders, and even afraid of cold hot, sweat, thirst, dizziness, fatigue, constipation or diarrhea, tongue and pulse condition and performance are different in individual patients.these so-called"and"seemingly have nothing to do with the disease, which is really reflect the pathological changes of the human internal organs appeared.that is to say,"and"hidden behind the"root"disease is the disease, and the acid heartburn is only local manifestation of the disease in the esophagus, is part of the disease all performance.only for human viscera dysfunction of the"root"disease treatment, can radically cure the disease.
it is based on this knowledge, so the doctor of traditional chinese medicine treatment for heartburn and reflux, but pay more attention to cause, as to the cause of gastrointestinal dynamic obstacles such as eating, mood swings, mental stress, the treatment such as insomnia, that is to say, chinese pay more attention to the body symptoms of patients with modulation.through the primary symptom, and comprehensive"syndrome differentiation", it is concluded that a core of"mechanism", to develop targeted"solution", offer individualized tcm"prescription", namely unique"syndrome differentiation"of traditional chinese medicine, can get satisfactory result;for western medicine focus too much on the so-called"acid"suppression"promoting gastric dynamics""repair mucous membrane of stomach esophagus"traditional chinese medicine(tcm), instead of on the back burner.in general, proprietary chinese medicine is simple and practical, but to adapt to the scope too narrow, for the majority of patients do not apply;conditional, or please experienced doctor effect of traditional chinese medicine medicinal broth.
(text/li xl chief physician beijing university of chinese medicine dongzhimen hospital)
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