（图片选自Healthday News）

胃食管反流病（gastroesophageal reflux disease，GERD）并不罕见，其最典型的症状是烧心和反流。另外，亦可有胸痛、吞咽困难，重者甚至可并发咽喉炎、慢性咳嗽、哮喘、上消化道出血、食管狭窄和癌变等。因此，积极防治该病具有重大的现实意义。

诊断胃食管反流病最直接、最可靠的方法是内镜检查。另外，食管滴酸、测压、吞钡和pH监测等检查亦助于本病的诊断。

治疗该病的一般方法包括戒烟限酒，低脂饮食，少食咖啡浓茶，避免肥胖、便秘和腰带过紧，和睡眠时抬高床头等；特殊治疗的方法则有服用抑制胃酸分泌药（如西咪替丁、奥美拉唑等）和抗反流手术等。

那么经一般方法治疗无效的患者究竟是选择药物抑或是接受手术治疗？日前有文献就药物和手术治疗该病之疗效进行了比较，结果提示服用质子泵抑制剂（如奥美拉唑）与采取手术治疗该病的临床疗效相当，但两种治疗方法之主要区别在于接受药物治疗者几乎是需要终生服药，可手术治疗者术后无需服药，但手术存在一定的风险，且术后易患腹胀或胃肠胀气。因此，究竟胃食管反流病的患者接受何种治疗？需要患者与他或她的医生协商确定。

更多资讯，请参阅原文。

Pills, Surgery Both Effective for Chronic Reflux: Study

Each approach seems to ease condition, each has pluses and minuses, experts say

TUESDAY, May 17 (HealthDay News) -- Both surgery and popular medications such as Nexium, Prevacid or Prilosec can successfully treat the discomfort of chronic reflux, according to new research.

Millions of Americans experience what's known formally as chronic gastroesophageal reflux disease, or GERD. The condition is caused by acidic stomach contents washing up into the esophagus. GERD can have a debilitating effect on sleep, work and general quality of life.

However, "we have made very dramatic improvement in our treatment of GERD, that's the good news," said lead researcher Dr. Jean-Paul Galmiche, a professor of gastroenterology in the College of Medicine at Nantes University in France. 　Treatments include laparoscopic surgical fixes and the use of proton pump inhibitor (PPI) drugs such as Nexium (esomeprazole), Prilosec (omeprazole) and Prevacid (lansoprazole).

The new study -- which was funded by Nexium's maker, AstraZeneca -- found "dramatic improvement in the results of surgery and excellent results also with medical therapy," he stated. There was no real difference between the medical and surgical approaches in terms of their overall ability to ease GERD, "which was not expected," Galmiche said.

Each treatment option did have its merits and demerits, however. For example, with surgery there is less regurgitation than with the medications, Galmiche said, but on the other hand, "you have more bloating and flatulence after surgery."

This means that the choice of one treatment over the other is really up to the patient, he said. If you don't want to take pills for the rest of your life you may opt for surgery, or if you fear surgical complications you can opt for PPIs. "You can choose your preferred treatment," Galmiche said.

The report was published in the May 18 issue of the Journal of the American Medical Association.

The study included 554 people with GERD who had already responded well to Nexium in a three-month try-out period prior to their entry into the study. These participants were selected because, according to one outside expert, people with reflux who do not respond to a PPI probably have another condition other than GERD.

"Those are [also] the people who tend to not do as well on surgery, because a lot of them have non-acid reflux or another cause of their symptoms," explained Dr. Amar R. Deshpande, an assistant professor of gastroenterology at the University of Miami Miller School of Medicine.

Of the 554 people selected into the trial, 372 completed five years of follow-up, including 192 randomly assigned to treatment with Nexium and 180 assigned to laparoscopic antireflux surgery.

Although the study used Nexium as its PPI, Galmiche pointed out that there is no reason why other drugs in this class wouldn't work as well.

People taking Nexium were allowed to increase their dose as needed, the investigators noted.

Five years after initiating treatment, the researchers found that GERD was in remission for 85 percent of the patients who had undergone surgery and 92 percent of the patients who were taking Nexium.

Those taking Nexium had similar levels of heartburn and acid regurgitation from the start to the end of the study. However, these symptoms lessened among those who had surgery, the researchers noted.

For example, at five years, 13 percent of those taking Nexium had acid regurgitation compared with 2 percent of those who underwent surgery. Yet there was no significant difference between the groups in the severity of heartburn, abdominal pain or diarrhea, the investigators found.

In terms of complications, 11 percent of the surgery patients had difficulty swallowing, compared with 5 percent of those taking Nexium. Among those having surgery, more suffered bloating than those taking Nexium (40 percent versus 28 percent) and the same held for rates of (excess) flatulence (57 percent versus 40 percent), the researchers found.

In addition, about 29 percent of those who had surgery and 24 percent of those on Nexium experienced some serious adverse event.

Overall, however, "this large, multicenter randomized trial demonstrated that with modern forms of antireflux therapy, either by drug-induced acid suppression or after laparoscopic antireflux surgery, most patients remain in remission for at least five years," the study authors concluded.

Commenting on the study, Deshpande said that "if you did well on Nexium and if you continued it or went to surgery, both afforded you a nine out of 10 chance of staying in symptom remission over the next five years."

As he sees it, GERD therapy typically becomes a personal choice. "If you are taking one pill once a day, most people tend to want to do that [rather] than undergo surgery," he said. However, it is those who do well on a PPI that typically also do well after surgery, he noted.

People who might opt for surgery are those who don't want to take pills or are afraid of the side effects of PPIs, Deshpande said.

SOURCES: Jean-Paul Galmiche, M.D., professor, gastroenterology, College of Medicine, Nantes University, France; Amar R. Deshpande, M.D., assistant professor, gastroenterology, University of Miami Miller School of Medicine; May 18, 2011, Journal of the American Medical Association