ILD患者的GERD
胃食管反流病(GERD), 也被称为反酸, occurs when stomach contents back up – or reflux – into the esophagus. This can be due to weakening of the muscle where the esophagus meets the stomach, 叫做食管下括约肌, or to problems with the contractions of the esophagus or stomach.
Many studies have shown a link between GERD and lung disease, including 间质性肺病(ILD). 这种关系的原因尚不清楚. One theory suggests that reflux may play a role in the development of certain lung diseases. The link between ILD and GERD is an active area of research in the UCSF ILD Program.
体征和症状
胃反流的常见症状包括:
- Heartburn (burning sensation in the center of the chest)
- 食物和液体的反流
- 喉咙里有酸味
- 胸部疼痛
- 咳嗽
不太常见的症状包括胃痛, 喉咙痛, 沙哑的声音, 吞咽困难或疼痛, 复发性肺炎, 哮喘, chronic sinus infection or a sensation of a lump in the throat.
诊断
在普通人群中, doctors can often diagnose GERD by taking a medical history and performing a physical examination. ILD患者, 诊断更为复杂, as patients may have unusual symptoms or may lack symptoms. In ILD patients, additional testing is often needed to diagnose GERD.
In addition to taking a medical history and performing a physical exam, 你的十大赌博平台排行榜可能会建议你做以下检查:
- 食管pH监测. This is the most direct way to measure the frequency of acid reflux. The test involves inserting a thin tube into the nose and down into the esophagus. The tube is left in for 24 hours while it measures how much stomach acid is getting into the esophagus.
在测试期间,您可以正常饮食. Most patients have very few side effects from the test, the most common being a 喉咙痛. Once the test is complete, you'll need to return to have the tube removed. - 食管测压法. By measuring the muscle contractions of your esophagus, this test can tell your doctor if your lower esophageal sphincter is functioning properly. The test is often done at the same time as the initial placement of the 24-hour pH monitor.
- 上GI系列. 也叫吞钡, this test can help your doctor determine if you have a swallowing problem that may mimic signs and symptoms of GERD. 该检查包括吞钡, 在x射线上显示的造影剂, while a technician takes an X-ray series of your chest and neck.
- 内窥镜检查. This procedure allows us to see your esophagus with an endoscope, 照相机安装在一个小的, 挠性管. 内窥镜检查 is performed by a gastroenterologist and is an outpatient procedure. The test reveals if there's any damage to the lining of the esophagus from chronic acid exposure.
Your doctor may recommend an endoscopy if you're experiencing painful swallowing, unexplained weight loss or bleeding (dark-colored stools or vomiting blood).
治疗
The treatment for GERD depends on the severity of the disease. All patients should make changes to their diet and lifestyle to reduce the symptoms and complications of GERD.
It's important for patients to realize that we don't know if treating GERD influences the course of the underlying lung disease. 然而, patients should discuss treatment with their doctors, in order to avoid the long-term complications of uncontrolled GERD.
生活方式的改变
生活方式的改变包括:
- 减肥
- 戒烟
- Raising the head of your bed 6 to 8 inches – you can use either blocks of wood under the legs of your bed, 或者床垫下的泡沫楔子
- 避免引起胃酸反流的食物:咖啡因, 巧克力, 酒精, 薄荷, 以及油腻或辛辣的食物
- Avoiding large and late meals – don't lay down immediately after eating, 睡前三小时或更久吃东西
药物
治疗轻度反流的药物包括:
- 抗酸药. 这些提供了短期的缓解. 例如Tums, Maalox和Mylanta.
- 组胺拮抗剂. 这些能减少胃酸的产生, 但它们不如质子泵抑制剂有效, 下面描述. Examples include ranitidine (Zantac), famotidine (Pepcid) and cimetidine (Tagamet).
治疗中度至重度胃反流的药物:
- 质子泵抑制剂(PPI). PPIs可以减少胃酸的产生. 例子包括奥美拉唑(奥美拉唑), esopmeprazole(埃索美拉唑), lansoprazole (Prevacid), dexlansoprazole (Kapidex), 泮托拉唑(Protonix)和雷贝拉唑(Aciphex).
These medications are generally safe and well tolerated, but if taken for long periods of time they may increase the risk of pneumonia, 肠道感染或骨折.
如果这些治疗不能控制你的症状, your doctor may consider a different PPI or increase the dose of your PPI. In the most severe circumstances, your doctor may recommend surgical treatment for your GERD.
加州大学旧金山分校健康 medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.