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Proposed approach to the challenging management of progressive gastroesophageal reflux disease

查看全文 作　　者：Joachim [1]Labenz;Parakrama T [2]Chandrasoma;Laura J [3]Knapp;Tom R [2]DeMeester 高影响力作者 机构地区：[1]Diakonie Klinikum,Jung-Stilling Hospital,Siegen 57074,Germany;[2]Keck School of Medicine,University of Southern California,Los Angeles,CA 91108,United States;[3]PharmaGenesis London,London SW1A 2DD,United Kingdom高影响力机构 出　　处：《World Journal of Gastrointestinal Endoscopy》索引2018年第10卷第9期,共9页高影响力期刊 摘　　要：The progression of gastroesophageal reflux disease(GERD) in patients who are taking proton pump inhibitors(PPIs) has been reported by several investigators,leading to concerns that PPI therapy does not address all aspects of the disease.Patients who are at risk of progression need to be identified early in the course of their disease in order to receive preventive treatment.A review of the literature on GERD progression to Barrett's esophagus and the associated physiological and pathological changes was performed and risk factors for progression were identified.In addition,a potential approach to the prevention of progression is discussed.Current evidence shows that GERD can progress;however,patients at risk of progression may not be identified early enough for it to be prevented.Biopsies of the squamocolumnar junction that show microscopic intestinalization of metaplastic cardiac mucosa in endoscopically normal patients are predictive of future visible Barrett's esophagus,and an indicator of GERD progression.Such changes can be identified only through biopsy,which is not currently recommended for endoscopically normal patients.GERD treatment should aim to prevent progression.We propose that endoscopically normal patients who partially respond or do not respond to PPI therapy undergo routine biopsies at the squamocolumnar junction to identify histological changes that may predict future progression.This will allow earlier intervention,aimed at preventing Barrett's esophagus. 关 键 词：Barrett's esophagus Gastroesophageal reflux disease ENDOSCOPY PROGRESSION Treatment
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