事件记录
Dr. 米勒: 胃灼热，什么时候会成为关注的焦点，下一期节目是Scope Radio.
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Dr. 米勒: 你好，我是汤姆·米勒，和我在一起的是. 博因顿凯萨琳, and she is a doctor in the Department of Medicine and she is a gastroenterologist, 肠道疾病专家. 她也是副教授. 她今天在大发娱乐谈论的是胃灼热.
凯瑟琳，什么时候胃灼热... 每个人都有心痛的时候，对吧? 我的意思是, you have that big chili cook-off and a couple of hours later you're really resenting that and you're reaching for the sodium bicarbonate, 或者你要吃Tums. 一个人有多少次胃灼热而不担心呢? Or conversely, when should somebody worry that they're having heartburn too often?
Dr. 影响: Well the truth is nobody has ever done the study where they 说 this frequency equals a severe disease. 但通常我会告诉别人, if you're having it two to three times a week that's probably enough to see your physician. The other concern of course is if you come from a family with a history of esophageal cancer, 也许任何程度的胃灼热都足以让你看到某人.
Dr. 米勒: I know a lot of patients will have heartburn maybe three times a week, and then they just have gone to the store and they've bought several different kinds of antacids. 如果有效，你认为他们还需要看医生吗?
Dr. 影响: 我认为他们有, because we know that the way you feel doesn't necessarily match what's going on inside your gut. And your concern is to prevent the complications that are irreversible, 这与胃灼热有关.
Dr. 米勒: 长期的胃灼热，这些并发症是什么?
Dr. 影响: 食道会有疤痕组织. 食道是有弹性的, so if you inadvertently swallow a big piece of food it can still distend, 拉伸食道并向下进入胃. 如果你有疤痕组织，它就无法通过, 大发娱乐值班的时候总是会遇到障碍, 哪里有人有一块肉, 说, 它卡在食道里，无法通过.
Dr. 米勒: 长期的胃灼热会导致食道疤痕, the narrowing of the esophagus so that you can't pass food and is a dangerous situation.
Dr. 影响: 正确的.
Dr. 米勒: 那么这个叫做巴雷特食管的术语呢? Some patients will come in and they've read about it on the Internet or heard it on TV shows about Barrett's esophagus and its relationship to heartburn.
Dr. 影响: 是的. Barrett's is a concerning change in the tissue and it develops as a result of exposure to acid, 会引起炎症. 炎症意味着组织必须重新生长. And sometimes the tissue makes a mistake and it grows to look more like the tissue we see in the stomach, 然后是十二指肠. And the problem with that is a small percentage of those people that have that Barrett's tissue will go on to develop esophageal cancer. So our question is when we see a patient with heartburn, are they somebody that may have Barrett's? 大发娱乐如何决定是否调查这个问题?
Dr. 米勒: Now there are age cutoffs 我认为; the older a person is the more likely a physician is likely to recommend diagnostics. Can you talk a little bit about that and when you decide as a gastroenterologist that a patient might in fact need a study, 或者向下看一下组织是什么样子的, 看看他们是否有巴雷特的食道?
Dr. 影响: 在医学上，大发娱乐有所谓的指导方针, 它们在某种程度上是基于关联的, because we want to be efficient and not do unnecessary testing on patients. The recommendation is that in a white male over the age of 40 who has a history of heartburn that we do an endoscopy, 内窥镜检查可以大发娱乐大发娱乐. We can see the Barrett's tissue; it looks different from normal tissue.
Dr. 米勒: 内窥镜检查，大发娱乐能给一些人澄清一下吗. That's a tube that goes down with a light on the end of the scope and they can actually see the tissue in the esophagus. 他们甚至可以做活组织检查.
Dr. 影响: 正确的. And based on those biopsies we can tell someone whether or not they have Barrett's disease. If they have Barrett's then we recommend that they be monitored with endoscopy and the frequency can be in a year, 或者可以每三年一次, 取决于配置文件.
Dr. 米勒: 现在医生可能也会决定治疗, and are there effective treatments for heartburn that can make it better?
Dr. 影响: 绝对. 它们甚至可以在柜台上买到. The most effective are what we call the proton pump inhibitors, and there is a whole bunch of those. 但非处方药是奥美拉唑, 或奥美拉唑, 这可能是最常用的药物.
Dr. 米勒: 当你去买奥美拉唑的时候它可能更便宜，对吧?
Dr. 影响: 是的.
Dr. 米勒: 每天服用, 我认为, is pretty much what's prescribed for people who have heartburn three or more times a week. And I've found most patients do very well with that; it's very effective.
Dr. 影响: 是的.
Dr. 米勒: 它还能阻止胃灼热.
Dr. 影响: 是的，没错.
Dr. 米勒: Now what happens if a person is taking one of these medications and they're breaking through?
Dr. 影响: 在医生的脑子里, 当他们看到那些病人时, what they are wondering is first of all do I have the diagnosis correct. 这还是酸吗？? But assuming that it is still acid, we will increase their medication. If that doesn't work there is even surgery that will fix the underlying mechanical problem that causes reflux.
Dr. 米勒: Now how often in your experience would a patient not respond to medication to reduce or to eliminate heartburn and need to go on to surgery? 这种情况多久发生一次?
Dr. 影响: 我没有确切的数字，但不到10%的病人是这样. Sometimes patients will elect to have the surgery for lifestyle reasons. They just don't want to be on a medication long term, and that's a valid consideration.
Dr. 米勒: So it sounds like the take-home points are; one, 如果你一周有三次以上的胃灼热, you should probably see your physician and have him decide if additional diagnostic studies should be done; or if they would just go ahead and prescribe a medication, 比如奥美拉唑可以消除胃灼热. And if you're having heartburn and you're taking a medication for heartburn, you really should probably see your physician about it for additional diagnostic studies.
Dr. 影响: 正确的.
Dr. 米勒: 非常感谢.
Dr. 影响: 不客气.
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