Цель обследования, направленного на оценку функции пищевода, -- выяснить, какие физиологические механизмы лежат в основе заболеваний пищевода и наблюдающихся у пациентов симптомов, и выбрать оптимальные методы лечения. На сегодня больным с типичными симптомами желудочно-пищеводного рефлюкса не рекомендуется проводить пищеводную манометрию и рН-метрию, поскольку терапия первой линии не зависит от результатов этих исследований [1]. Однако, по мере того как все большему числу пациентов эмпирически назначают ИПП, становится ясно, что такое лечение помогает не всем и устраняет не все симптомы. Сочетанное применение рН-метрии и многоканальной внутриполостной импедансометрии показало, что частая причина сохранения жалоб на фоне лечения -- щелочной рефлюкс [40]. Возможно, пожилым пациентам со стойкими симптомами рефлюкса, у которых противорефлюксный барьер функционирует нестабильно или его структура нарушена, показаны немедикаментозные методы лечения (например, фундопликация), а пациентам с нарушением функции НПС -- лекарственные средства, подавляющие ПРНПС (например, баклофен).Хирургическое вмешательство в подобных случаях не всегда подходит, а эндоскопические противорефлюксные процедуры пока не внедрены в клиническую практику [1]. В любом случае данное исследование показало, что для предупреждения возрастного увеличения тяжести ГЭРБ могут применяться методы, направленные на восстановление нормальной структуры противорефлюксного барьера.
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