老年胃食管反流病中西医发病机制及治疗研究进展^*

Pathogenesis and treatment of elderly GERD: integrative insights from traditional Chinese medicine and Western medicine

摘要

胃食管反流病(GERD)是老年人常见疾病,因其独特的生理病理机制,临床症状不典型,易漏诊误诊。现代医学治疗以质子泵抑制剂(PPI)及内镜技术为主,虽有一定疗效,但长期用药不良反应较多,内镜治疗受限于老年基础病。近年来,中医及中西医结合治疗在老年GERD领域不断取得进展,中西医联合方案可协同增效,减少西药依赖及复发风险。本文对老年GERD的临床特殊性、中医辨证论治及中西药联用、内外治结合等综合干预策略作一综述,为优化老年GERD个体化治疗提供参考,反映当前中西医结合治疗的新思路与实践进展。

Abstract

Gastroesophageal reflux disease (GERD) is prevalent among the older population. Its distinctive pathophysiology results in atypical clinical symptoms, facilitating the likelihood of oversight or misdiagnosis. Contemporary medical interventions mostly encompass proton pump inhibitors (PPI) and endoscopic procedures. While these treatments are efficacious, prolonged use of PPIs may result in numerous adverse effects, and endoscopic interventions are constrained by the underlying conditions of the elderly. In recent years, traditional Chinese medicine (TCM) and combined TCM-Western medicine methodologies have advanced in the treatment of elderly people with GERD. TCM emphasizes syndrome differentiation and personalized therapy, providing a comprehensive approach. The integration of TCM treatment and Western treatment can improve effectiveness, diminish reliance on Western pharmaceuticals, and decrease the likelihood of recurrence. This article delineates the clinical features of elderly with GERD, TCM syndrome distinction, and integrated therapeutic approaches. This encompasses combinatory tactics of TCM and Western pharmaceuticals, as well as internal and external therapies, offering references for enhancing personalized treatment for elderly patients with GERD and illustrating novel concepts and advancements in integrated TCM-Western medical care.

关键词

胃食管反流病 / 发病机制 / 中西医治疗

Key words

Gastroesophageal reflux disease / Pathogenesis / Integrated traditional Chinese and Western medicine treatment

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基金资助

^*国家自然科学基金资助项目(82305074);国家中医药管理局中国中医药科技发展中心联合研究项目(CXZH202304);国家中医药管理局中医药循证能力提升项目(2019XZZX-XH005);河南省中医药传承与创新人才工程(仲景工程)中医药学科领军人才项目(豫卫中医函[2021]08号);2022年度河南省重点研发与推广专项(科技攻关)支持项目(222102310240);河南省中医药科学研究专项(2023ZY2074)