แนวทางการวินิจฉัยและรักษาโรคกรดไหลย้อน

1. ·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“‚√§°√¥‰À≈¬âÕπ„πª√–‡Σ»‰Σ¬
®“°°“√ª√–™ÿ¡
2004 Consensus for Clinical Practice Guideline
for the Management of Gastroesophageal Reflux Disease
®—¥Σ”‚¥¬
™¡√¡‚¡Π‘≈‘μ’È·Ààߪ√–‡Σ»‰Σ¬
¡“§¡·æΣ¬å√–∫∫Σ“ß‡¥‘πÕ“À“√·Ààߪ√–‡Σ»‰Σ¬

2. ·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“
‚ √ § ° √ ¥ ‰ À ≈ ¬â Õ π „πª√–‡Σ»‰Σ¬
·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“‚√§°√¥‰À≈¬âÕπ„πª√–‡Σ»‰Σ¬
‚¥¬™¡√¡‚¡Π‘≈‘μ’È·Ààߪ√–‡Σ»‰Σ¬
¡“§¡·æΣ¬å√–∫∫Σ“ß‡¥‘πÕ“À“√·Ààߪ√–‡Σ»‰Σ¬
æ‘¡æå§√—Èß·√° З𫓧¡ 2547
ISBN 974-9716-98-1
§≥–ºŸâ®—¥Σ”
Σ’Ëª√÷°…“ : πæ.∫—≠™“ ‚Õ«“ΣÓ√æ√
2
: πæ. ‘π Õπÿ√“…Ø√å
: πæ.æ‘π‘® °ÿ≈≈–«≥‘™¬å
: æ≠.«—π¥’ «√“«‘Σ¬å
ª√–Π“π : πæ.Õÿ¥¡ §™‘πΣ√
‡≈¢“πÿ°“√ : πæ. ¡™“¬ ≈’≈“°ÿ»≈«ß»å
°√√¡°“√ πæ.°‘μμ‘ ®—πΣ√å‡≈‘»ƒΣΠ‘Ï
æ≠.‚©¡»√’ ‚¶…‘μ™—¬«—≤πå
æ≠.∫ÿ…∫“ «‘«—≤π凫§‘π
πæ.ª√–æ—πΠå Õà“π‡ª√◊ËÕß
æ≠.«‚√™“ ¡À“™—¬
æΣ.«“π‘™ ªî¬π‘√—π¥√å
πæ.«‘ΣŸ√ ™‘π «à“ß«—≤π°ÿ≈
πÕ.πæ.«‘≠êŸ ®—πΣ√ ÿπΣ√°ÿ≈
πæ.»μ«√√… ΣÕß «— ¥‘Ï
πæ. ÿ‡Σæ °≈™“≠«‘Σ¬å
πæ.‡ ° ‘μ ‚Õ ∂“°ÿ≈
æÕ.πæ. ÿ√æ≈ ÿ√“ߧå»√’√—∞
æ≠. ÿæ√ μ√’æß…å°√ÿ≥“
πæ. ÿ√‘¬– ®—°°–æ“°
ÕÕ°·∫∫·≈–®—¥Σ”√Ÿª‡≈à¡‚¥¬
∫√‘…—Σ ¬Ÿ‡π’ˬπ §√’‡Õ™—Ëπ ®”°—¥
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3. Guideline for the
management of GERD
3
§”π”
„π™à«ß 5-10 ªïΣ’Ëºà“π¡“ ‚√§°√¥‰À≈¬âÕπ (Gastroesophageal
Reflux Disease, GERD) ‡ªìπ‚√§Σ’Ëæ∫‰¥â∫àÕ¬¡“°¢÷Èπ„π¿Ÿ¡‘¿“§‡Õ‡™’¬√«¡
Σ—Èߪ√–‡Σ»‰Σ¬ ‚¥¬„π™à«ß 5 ªïÀ≈—ßæ∫¡’§«“¡™ÿ°¢Õß‚√§°√¥‰À≈¬âÕπ„π
ª√–‡Σ»‰Σ¬‡æ‘Ë¡¢÷Èπª√–¡“≥ 2 ‡Σà“ §◊Õæ∫¡’§«“¡™ÿ°ª√–¡“≥√âÕ¬≈– 10-
15 ¢ÕߺŸâªÉ«¬Σ’Ë¡“¥â«¬Õ“°“√ dyspepsia ‚√§°√¥‰À≈¬âÕπ‡ªìπ‚√§Σ’Ë
«‘π‘®©—¬‰¥â§àÕπ¢â“߬“° ‡π◊ËÕß®“°Õ“»—¬°“√´—°ª√–«—쑇ªì𠔧—≠ Õ“°“√
®”‡æ“–¢Õß‚√§π’ȧ◊Õ heartburn ´÷Ë߉¡à¡’§”·ª≈‡ªìπ¿“…“‰Σ¬‚¥¬μ√ß·≈–
¬—ß¡’§«“¡‡¢â“„®Σ’Ë·μ°μà“ß°—π„π°“√ ◊ËÕ§«“¡À¡“¬¢Õߧ”«à“ heartburn ‚¥¬
‡©æ“–„πª√–™“™πΣ—Ë«‰ª ·≈–‚√§π’Ȭ—߉¡à¡’°“√ ◊∫§âπ„¥Σ’Ë®”‡æ“–Σ’Ë®–™à«¬
„π°“√«‘π‘®©—¬ πÕ°®“°π’È≈—°…≥–Σ“ß§≈‘π‘°¡’Σ—ÈßΣ’Ë‡ªìπ typical ·≈– atypi-cal
GERD ·¡â„πªí®®ÿ∫—π®–¡’¬“Σ’Ë„Àâº≈„π°“√—°…“§àÕπ¢â“ߥ’·μà≈—°…≥–
°“√¥”‡π‘π‚√§¡—°‡√◊ÈÕ√—ß·≈–‡ªìπÊÀ“¬Ê πÕ°®“°π’È„πºŸâªÉ«¬Σ’ˇªìππ“π‡ªìπ
‘∫ªï∫“ß√“¬Õ“®π”‰ª Ÿà°“√‡°‘¥¡–‡√ÁߢÕßÀ≈Õ¥Õ“À“√‰¥âÕ’°¥â«¬ ™¡√¡
‚¡Π‘≈‘μ’È·Ààߪ√–‡Σ»‰Σ¬ ¿“¬„μâ ¡“§¡·æΣ¬å√–∫∫Σ“ß‡¥‘πÕ“À“√·Ààß
ª√–‡Σ»‰Σ¬ ‰¥â‡≈Á߇ÀÁ𧫓¡ ”§—≠„π°“√Σ’Ë·æΣ¬å®– “¡“√∂„Àâ°“√
«‘π‘®©—¬·≈–√—°…“√«¡Σ—Èß°“√ª√–‡¡‘π·≈–μ‘¥μ“¡ºŸâªÉ«¬‚√§°√¥‰À≈¬âÕπ‰¥â
Õ¬à“ß∂Ÿ°μâÕß ‡À¡“– ¡ ®÷߉¥â®—¥°“√ª√–™ÿ¡ consensus ‡æ◊ËÕ®—¥Σ”
·π«Σ“ß°“√«‘π‘®©—¬·≈–¥Ÿ·≈√—°…“‚√§°√¥‰À≈¬âÕπ„πª√–‡Σ»‰Σ¬¢÷Èπ ‚¥¬
„Àâ·æΣ¬åΣ’ËÕ¬Ÿà„π‚√ß欓∫“≈Σÿ°√–¥—∫ “¡“√∂π”·π«Σ“ß°“√«‘π‘®©—¬·≈–
√—°…“π’ȉªªØ‘∫—쑉¥â®√‘ß °“√ª√–™ÿ¡¥—ß°≈à“«¡’ºŸâ‡¢â“√à«¡ª√–™ÿ¡ª√–°Õ∫¥â«¬
Õ“¬ÿ√·æΣ¬å¥â“π√–∫∫Σ“ß¥‘πÕ“À“√, »—≈¬·æΣ¬å, ·æΣ¬åºŸâ‡™’ˬ«™“≠¥â“π
√–∫∫°“√À“¬„®, ·æΣ¬åºŸâ‡™’ˬ«™“≠¥â“π ENT, Õ“¬ÿ√·æΣ¬åΣ—Ë«‰ª ·≈–
·æΣ¬å‡«™ªØ‘∫—μ‘Σ—Ë«‰ª ¡“√à«¡°—π„À⧫“¡‡ÀÁπ Õ¿‘ª√“¬·≈– √ÿª‡ªìπ
·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“‚√§°√¥‰À≈¬âÕππ’È¢÷Èπ ¡“§¡®–‰¥â¡’°“√
¥”‡π‘π°“√·®°®à“¬·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“π’È„Àâ·°à·æΣ¬åΣ—Ë«ª√–‡Σ»

4. 4
·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“
‚ √ § ° √ ¥ ‰ À ≈ ¬â Õ π „πª√–‡Σ»‰Σ¬
√«¡Σ—Èß®–¡’°“√μ‘¥μ“¡ª√–‡¡‘πº≈ ·≈–ª√—∫ª√ÿß„Àâ‡À¡“– ¡¬‘Ëߢ÷ÈπμàÕ‰ª
¡“§¡·æΣ¬å√–∫∫Σ“ß‡¥‘πÕ“À“√·Ààߪ√–‡Σ»‰Σ¬¢Õ¢Õ∫§ÿ≥
·æΣ¬åΣÿ°Σà“πΣ’Ë‰¥â ≈–‡«≈“𔧫“¡√Ÿâ·≈–ª√– ∫°“√≥å¡“√à«¡„π°“√®—¥Σ”
·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“‚√§°√¥‰À≈¬âÕπ„πª√–‡Σ»‰Σ¬π’È ·≈–¢Õ
¢Õ∫§ÿ≥ ∫√‘…—Σ ·Õ μ√Ⓡ´π‡π°â“ (ª√–‡Σ»‰Σ¬) ®”°—¥ Σ’Ë™à«¬ π—∫ πÿπ
°“√®—¥°“√ª√–™ÿ¡‚¥¬‰¡à¡’‡ß◊ËÕπ‰¢„¥ÊΣ”„Àâß“π ”‡√Á®≈ÿ≈à«ß‰ª‰¥â¥â«¬¥’ ¡
§«“¡¡ÿàßÀ¡“¬
√».πæ.∫—≠™“ ‚Õ«“ΣÓ√æ√
𓬰 ¡“§¡·æΣ¬å√–∫∫Σ“ß‡¥‘πÕ“À“√·Ààߪ√–‡Σ»‰Σ¬

5. Guideline for the
management of GERD
5
Guideline Algorithm for the Management of GERD
Guideline π’È®—¥Σ”¢÷Èπ‡æ◊Ëՙ૬·æΣ¬å„π°“√¥Ÿ·≈√—°…“ºŸâªÉ«¬Σ’Ë¡’ªí≠À“
reflux ·≈–¿“«–·Σ√°´âÕπΣ’Ë‡°‘¥®“° reflux ‚¥¬„Àâæ‘®“√≥“„™â°—∫ºŸâªÉ«¬
GERD Σ’Ë¡’Õ“°“√®π¡’ªí≠À“μàÕ§ÿ≥¿“æ¢Õß™’«‘μ (quality of life)
°“√ÕΠ‘∫“¬ guideline ®–‡ªìπ‰ªμ“¡ algorithm ‚¥¬μ—«‡≈¢Σ’Ë
°”°—∫„π·μà≈– à«π¢Õß algorithm ®–μ√ß°—∫§”∫√√¬“¬„π·μà≈–À—«¢âÕ
Symptoms suggestive of GERD
No Alarm
Typical
LSM plus
Standard dose
PPI 4 wks
Symptom
persist
Yes
ë Dysphagia
ë Odynophagia
ë Frequent vomiting
ë GI bleed / anemia
ë Weight loss
Atypical
* Exclude other conditions
LSM plus
Double dose PPI 2 wks
(consider 4-12 wks for
atypical GERD)
Symptom
persist
Symptom free
Stop
Rx
Symptom
free
Maintain
for at least 4 wks Symptom
persist
EGD/
Re-evaluation
Symptom improve
Recurrent symptom
Maintenance therapy
- On-demand/Intermittent Rx
- Continuous therapy
Alarm symptoms
3
1
2
7
4
8
9
10
10
11
5
6

6. 6
·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“
‚ √ § ° √ ¥ ‰ À ≈ ¬â Õ π „πª√–‡Σ»‰Σ¬
1. Symptoms suggestive of GERD
𑬓¡¢Õß GERD À¡“¬∂÷ß‚√§Σ’ˇ°‘¥®“°§«“¡º‘¥ª°μ‘Σ’Ë‡√◊ÈÕ√—ßΣ’Ë
‡°’ˬ«¢âÕß°—∫°“√Σ’Ë¡’ refluxate (content Õ–‰√°Á‰¥âΣ’ËÕ¬Ÿà„π°√–‡æ“–
Õ“À“√) ‰À≈¬âÕπ¢÷Èπ¡“ ŸàÀ≈Õ¥Õ“À“√ ´÷ËßÕ“®®–¡’À√◊Õ‰¡à¡’√àÕß√Õ¬
¢Õß°“√Õ—°‡ ∫¢ÕßÀ≈Õ¥Õ“À“√°Á‰¥â ‚¥¬Õ“°“√Σ’Ë∫àß™’È«à“ºŸâªÉ«¬πà“®–
‡ªìπ‚√§ GERD ª√–°Õ∫¥â«¬ heartburn (Õ“°“√· ∫¬Õ¥Õ°) ·≈–/
À√◊Õ regurgitation (¢¬âÕπÀ√◊Õ ”√Õ°) ‡ªì𠔧—≠ πÕ°®“°π’ÈÕ“®
æ∫Õ“°“√Õ◊ËπÊ Õ’°‰¥â ‡™àπ water brash (πÈ”≈“¬ Õ), chest pain (‡®Á∫
Àπâ“Õ°), dysphagia (°≈◊π≈”∫“°) ·≈– odynophagia (°≈◊π‡®Á∫)
‡ªìπμâπ
”À√—∫Õ“°“√ epigastric pain ‰¡à∂◊Õ«à“‡ªìπÕ“°“√®”‡æ“–¢Õß
GERD ¥—ßπ—ÈπÀ“°ºŸâªÉ«¬¡’Õ“°“√ epigastric pain Õ¬à“߇¥’¬« „Àâ
æ‘®“√≥“¥Ÿ·≈ºŸâªÉ«¬·∫∫ dyspepsia ·Σπ
2. Alarm symptoms
ºŸâªÉ«¬Σ’Ë¡’Õ“°“√¥—ßμàÕ‰ªπ’È (´÷Ëß∂◊Õ«à“‡ªìπÕ“°“√‡μ◊Õπ À√◊Õ
—≠≠“≥Õ—πμ√“¬) Õ“Σ‘ °≈◊π≈”∫“°, °≈◊π‡®Á∫ (odynophagia), Õ“
‡®’¬π∫àÕ¬Ê À√◊Õ¡’ª√–«—μ‘Õ“‡®’¬π‡ªìπ‡≈◊Õ¥ À√◊Õ¡’Õ“°“√´’¥, πÈ”Àπ—°≈¥
À√◊Õ¡’‰¢â §«√Σ”°“√ ◊∫§âπ‡æ‘Ë¡‡μ‘¡Σ—πΣ’ ¥â«¬°“√ àÕß°≈âÕßμ√«®Σ“ß
‡¥‘πÕ“À“√ à«πμâπ (Esophagogastroduodenoscopy; EGD) À√◊Õ
°“√μ√«®Õ◊ËπÊΣ’Ë‡À¡“– ¡
3. Typical symptoms of GERD À¡“¬∂÷ßÕ“°“√®”‡æ“–Σ’ËÀ“°ºŸâªÉ«¬¡’
Õ“°“√¥—ß°≈à“«„À⧑¥«à“ºŸâªÉ«¬πà“®–‡ªìπ GERD Õ“°“√¥—ß°≈à“« §◊Õ heart-burn
·≈–/À√◊Õ regurgitation
4. Atypical symptoms of GERD
§◊ÕÕ“°“√Σ’Ë‰¡à®”‡æ“–«à“®–‡ªìπ‚√§ GERD ·μà‡ªìπÕ“°“√Σ’ËÕ“®
‡ªìπº≈¡“®“°‚√§ GERD ‰¥â·°à
4.1 Õ“°“√Σ’Ë‡°’ˬ«¢âÕß°—∫À≈Õ¥Õ“À“√ ‡™àπ retrosternal chest pain

7. Guideline for the
management of GERD
(Σ—Èßπ’ÈμâÕ߉¥â√—∫°“√μ√«®·≈â« «à“‰¡à‡ªìπ‚√§À≈Õ¥‡≈◊Õ¥À—«„®)
4.2 Õ“°“√Σ“ß√–∫∫‡¥‘πÀ“¬„® ‡™àπ chronic cough, hemopty-sis,
bronchitis, bronchiectasis ·≈– recurrent pneumonia
4.3 Õ“°“√Σ“ß√–∫∫ ÀŸ §Õ ®¡Ÿ° ‡™àπ hoarseness, throat clear-ing,
chronic laryngitis, otalgia, sinusitis À√◊Õ otitis media
‡ªìπμâπ
4.4 Õ“°“√Õ◊ËπÊ ‡™àπ øíπºÿ, ª“°¡’°≈‘Ëπ
7
5. °“√√—°…“¥â«¬ lifestyle modification (LSM)
‡ªìπ°“√·π–π”«‘Π’ªØ‘∫—μ‘μ—« ·≈–§«√°√–Σ”„πºŸâªÉ«¬Σÿ°√“¬ ´÷Ëß
ª√–°Õ∫¥â«¬
- °“√πÕπ‡μ’¬ßΣ’Ë¬°»’√…–„À⠟ߢ÷Èπ 15 ´¡. À√◊Õ 6-8 π‘È«øÿμ ‚¥¬
À≈’°‡≈’ˬ߰“√„™â‡μ’¬ßπÈ”
- °“√πÕπ„πΣà“μ–·§ß´â“¬
- °“√ª√—∫æƒμ‘°√√¡°“√°‘πÕ“À“√ „Àâ‡À¡“– ¡°—∫ºŸâªÉ«¬·μà≈–
√“¬ ‚¥¬æ‘®“√≥“«à“¡’§«“¡ —¡æ—πΠå°—∫Õ“°“√Σ’Ë‡ªìπÀ√◊Õ‰¡à ‡™àπ
- À≈’°‡≈’ˬßÕ“À“√¡—π¡“°Ê
- À≈’°‡≈’ˬßÕ“À“√Σ’Ë°√–μÿâπ„Àâ¡’Õ“°“√ ‡™àπ °“·ø ™ÁÕ§‚°·≈μ
Õ“À“√Σ’Ë¡’√ ‡ª√’Ȭ«®—¥ ‡§√◊ËÕߥ◊Ë¡·Õ≈°ÕOEÕ≈å À√◊ÕπȔ՗¥≈¡
Õ“À“√Σ’Ë¡’ à«πª√–°Õ∫¢Õß¡–‡¢◊Õ‡Σ» Õ“À“√ª√–‡¿Σ¡‘Èπμå
- À≈’°‡≈’ˬ߰“√πÕπÀ≈—ß°‘πÕ“À“√Õ¬à“ßπâÕ¬ 2 ™¡.
- À≈’°‡≈’ˬ߰“√°‘πÕ“À“√ª√‘¡“≥¡“°Ê „πÀπ÷Ëß¡◊ÈÕ
- À≈’°‡≈’ˬ߬“∫“ß™π‘¥Σ’ËÕ“®¡’º≈μàÕÀŸ√Ÿ¥¢ÕßÀ≈Õ¥Õ“À“√ ‡™àπ an-ticholinergics,
theophylline, tricyclic antidepressants, cal-cium
channel blockers, β-adrenergic agonists, alendronate
‡ªìπμâπ
- ߥÀ√◊Õ≈¥°“√ Ÿ∫∫ÿÀ√’Ë
- ≈¥πÈ”Àπ—° À“°¡’¿“«–Õâ«π

8. 8
·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“
‚ √ § ° √ ¥ ‰ À ≈ ¬â Õ π „πª√–‡Σ»‰Σ¬
¬“ proton pump inhibitors (PPIs) ¢π“¥¡“μ√∞“π Σ’Ë‡ªìπ equiva-lent
dose ª√–°Õ∫¥â«¬
Omeprazole 20 mg daily
Lansoprazole 30 mg daily
Pantoprazole 40 mg daily
Rabeprazole 20 mg daily
Esomeprazole 40 mg daily
„π°√≥’Σ’Ë‰¡à “¡“√∂„™â PPI ‰¥â Õ“®æ‘®“√≥“„™â H2-receptor
antagonist (H2RA) ‡™àπ cimetidine 800 mg, ranitidine 300 mg,
famotidine 40 mg μàÕ«—π ·Σπ‰¥â
6. Maintenance treatment / On-demand/intermittent therapy /
Continuous treatment
®ÿ¥¡ÿàßÀ¡“¬¢Õß°“√√—°…“ºŸâªÉ«¬Σ’ˇªìπ symptomatic GERD §◊Õ
°“√§«∫§ÿ¡Õ“°“√„À⺟âªÉ«¬ ∫“¬¥’‰ªμ≈Õ¥ ®÷ßμâÕߥŸ·≈√–¬–¬“« °“√
√—°…“„π√–¬–¬“«Õ“®‡ªìπ·∫∫ On-demand/intermittent therapy
À√◊Õ Continuous treatment
°“√√—°…“·∫∫ on-demand therapy ‡ªìπ°“√√—°…“„π°√≥’Σ’ËºŸâ
ªÉ«¬°≈—∫¡“¡’Õ“°“√Õ’°À≈—ß®“°Σ’ËÀ“¬·≈â« ‚¥¬„À⺟âªÉ«¬°‘𬓄π™à«ß
√–¬–‡«≈“Σ’Ë¡’Õ“°“√μ‘¥μàÕ°—π·≈–À¬ÿ¥¬“‡¡◊ËÕ‰¡à¡’Õ“°“√·≈⫇ªìπ‡«≈“
Õ¬à“ßπâÕ¬ 24 ™¡. à«π intermittent therapy ‡ªìπ°“√√—°…“‚¥¬
„À⬓„π¢π“¥Σ’Ë “¡“√∂§«∫§ÿ¡Õ“°“√ºŸâªÉ«¬‰¥â‡ªìπ™à«ß√–¬–‡«≈“ —ÈπÊ
‡™àπ 1-2 —ª¥“Àå·≈â«À¬ÿ¥¬“ ”À√—∫ continuous treatment ‡ªìπ°“√
√—°…“‚¥¬„À⬓μàÕ‡π◊ËÕ߇ªìπ√–¬–‡«≈“π“π ‚¥¬æ‘®“√≥“„™â„πºŸâªÉ«¬Σ’Ë
‰¡à “¡“√∂À¬ÿ¥¬“‰¥â‡π◊ËÕß®“°¬—ߧߡ’Õ“°“√μ≈Õ¥ À√◊Õ Õ“°“√¥’¢÷Èπ ·μà
¬—߉¡àÀ“¬¢“¥ √–¬–‡«≈“°“√°‘π¬“Õ“®π“π‡ªìπ‡¥◊Õπ®π∂÷ßÀ≈“¬ªï‰¥â
„π°√≥’ continuous treatment Õ“®æ‘®“√≥“„™â step down
strategy ¥—ßπ’È

9. Guideline for the
management of GERD
7. ºŸâªÉ«¬Σ’Ë¡’Õ“°“√atypical GERD §«√ ◊∫§âπ‡æ‘Ë¡‡μ‘¡‡æ◊ËÕ„Àâ·πà„®«à“
‰¡à¡’§«“¡º‘¥ª°μ‘Õ◊Ëπ °àÕπΣ’Ë®– √ÿª«à“ºŸâªÉ«¬‡ªìπ GERD ‡™àπ ºŸâªÉ«¬
Σ’Ë¡“¥â«¬‡ ’¬ß·À∫ §«√ª√÷°…“·æΣ¬åΣ“ß ÀŸ §Õ ®¡Ÿ° ºŸâªÉ«¬Σ’Ë¡“¥â«¬
Õ“°“√·πàπÀ√◊Õ‡®Á∫Àπâ“Õ° §«√ª√÷°…“·æΣ¬åºŸâ‡™’ˬ«™“≠‚√§À—«„®
‡ªìπμâπ
8. 8.1 „π°√≥’Σ’ËºŸâªÉ«¬‡ªìπ Extraesophageal GERD °“√√—°…“„Àâ
∂◊Õ«à“ºŸâªÉ«¬°≈ÿà¡π’ȇªìπºŸâªÉ«¬Σ’Ë¡’§«“¡√ÿπ·√ß ®÷ß·π–π”„Àℙ⬓ PPI
„π¢π“¥«—π≈– 2 §√—È߇ªìπÀ≈—° („Àâ°àÕπÕ“À“√‡™â“·≈–‡¬Áπ) ‡ªìπ
‡«≈“ 4-12 —ª¥“Àå„π‡∫◊ÈÕßμâπ ”À√—∫ non- cardiac chest pain
°“√„À⬓‡ªìπ√–¬–‡«≈“ 4-8 —ª¥“ÀåÕ“®®–‡æ’¬ßæÕ ”À√—∫°“√
√—°…“ „π¢≥–Σ’Ë°≈ÿà¡Õ◊Ëπ¡’·π«‚πâ¡Σ’Ë®–μâÕß„À⬓‡ªìπ‡«≈“π“π¢÷Èπ
®π∂÷ß 12 —ª¥“Àå
8.2 ºŸâªÉ«¬Σ’Ë¡’Õ“°“√ typical GERD Σ’ËÕ“°“√‰¡à¥’¢÷ÈπÀ≈—ß®“°‰¥â¬“„π
¢π“¥ standard dose ¢Õß PPI „Àâæ‘®“√≥“‡æ‘Ë¡¬“‡ªìπ 2 ‡Σà“
°≈à“«§◊Õ„Àâ PPI ‡™â“‡¬Á𠇪ìπ‡«≈“Õ’° 4-12 —ª¥“Àå°àÕπ®–
æ‘®“√≥“«à“°“√√—°…“π—Èπ‰¡à‰¥âº≈
9. ºŸâªÉ«¬Σ’ËμÕ∫ πÕßμàÕ°“√„À⬓ PPI „π¢π“¥ double dose §«√„Àâ
¬“μàÕ‡ªìπ‡«≈“Õ¬à“ßπâÕ¬ 4 —ª¥“Àå „π∫“ß°√≥’ºŸâªÉ«¬Õ“®μÕ∫ πÕß
¥’®π‰¡à¡’Õ“°“√°Áæ‘®“√≥“„ÀâÀ¬ÿ¥¬“‰¥â ¢≥–Σ’Ë°≈ÿà¡Σ’ˇªìπ
extraesophageal GERD Õ“®®–μâÕß„À⬓‡ªìπ·∫∫ long term main-tenance
therapy À√◊Õ„π∫“ß√“¬Õ“®æ‘®“√≥“„Àâ°“√√—°…“·∫∫ on-demand
·≈–/À√◊Õ intermittent therapy ‰¥â
9
Double dose PPI + Bed time H2RA
Double dose PPI
Full (standard) dose PPI
Half dose PPI
Standard dose H2RA + Prokinetics
Standard dose H2RA or Prokinetics
Highest efficacy
Lowest efficacy

10. 10
·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“
‚ √ § ° √ ¥ ‰ À ≈ ¬â Õ π „πª√–‡Σ»‰Σ¬
10. ºŸâªÉ«¬Σ’ˬ—ߧߡ’Õ“°“√Õ¬Ÿà·¡â«à“®–‰¥â√—∫¬“ PPI „π¢π“¥ double dose
‡ªìπ‡«≈“ 12 —ª¥“Àå·≈â« (symptom persist) ·π–π”«à“§«√‰¥â√—∫
°“√μ√«®§âπ‡æ‘Ë¡‡μ‘¡¥â«¬°“√Σ” EGD À√◊Õ„Àâª√–‡¡‘πÕ“°“√¢ÕߺŸâ
ªÉ«¬„À¡à·≈–Σ”°“√ ◊∫§âπ‡æ‘Ë¡‡μ‘¡μàÕ‰ª
11. EGD §«√‰¥â√—∫°“√μ√«®„π°√≥’μàÕ‰ªπ’È
11.1 ºŸâªÉ«¬Σ’Ë¡’ alarm symptoms ·≈–/À√◊Õ ß —¬¡’‚√§Õ◊ËπÊ Σ’Ë‰¡à„™à
GERD ‡™àπ‚√§·º≈„π°√–‡æ“–Õ“À“√, ¡–‡√Áß„π°√–‡æ“–Õ“À“√
oe≈oe ‡ªìπμâπ
11.2 ºŸâªÉ«¬Σ’Ë —ππ‘…∞“π«à“Õ“®¡’À≈Õ¥Õ“À“√Õ—°‡ ∫√ÿπ·√ß (severe
esophagitis) À√◊Õ¡’¿“«–·Σ√°´âÕπ¢Õß GERD ‡™àπ Barrettûs
esophagus
11.3 ºŸâªÉ«¬Σ’ˬ—ߧߡ’Õ“°“√Õ¬Ÿàμ≈Õ¥¢≥–Σ’Ë‰¥â√—∫°“√√—°…“À√◊Õ‰¡àμÕ∫
πÕßμàÕ°“√√—°…“
Severe Esophagitis
or Barrettûs
Normal Mild to moderate
esophagitis
Non-GERD
diagnosis
Endoscopy
Re-assessment
LSM/Intensify Treatment (1)
If GERD still considered
symptom persist
-GERD
Treat
13
Ambulatory pH appropriately
+GERD
Seek other
diagnosis
17
- LSM/Intensify Treatment ( 2 )
- Continue long term maintenance Rx
- or Consider anti-reflux procedures
14
12
11
15 16

11. Guideline for the
management of GERD
12. ºŸâªÉ«¬Σ’ˉ¥â√—∫°“√ àÕß°≈âÕß·≈â« ‰¡àæ∫§«“¡º‘¥ª°μ‘ §«√‰¥â√—∫°“√
11
ª√–‡¡‘π´È” ‚¥¬°“√´—°ª√–«—μ‘·≈–μ√«®√à“ß°“¬Õ¬à“ß≈–‡Õ’¬¥
13. „π°√≥’Σ’Ë¬—ß ß —¬«à“ºŸâªÉ«¬‡ªìπ GERD Σ—ÈßÊΣ’Ë°“√ àÕß°≈âÕߪ°μ‘ °“√
√—°…“¥â«¬ lifestyle modification ∂◊Õ‡ªìπÀ—«„® ”§—≠Σ’ËμâÕ߇πâπ°—∫ºŸâ
ªÉ«¬ Õ“Σ‘°“√πÕπ¬°»’√…– Ÿß®“°æ◊Èπ (15 ´¡.) ‰¡à§«√„Àâ„™â‡μ’¬ßπÈ”
·≈–·π–π”„ÀâπÕπμ–·§ß´â“¬Õ“®™à«¬„À⺟âªÉ«¬Õ“°“√¥’¢÷Èπ‰¥â
πÕ°®“°π—Èπ§«√Σ∫Σ«π°“√„™â¬“Õ¬à“ß≈–‡Õ’¬¥ (Intensify treatment 1)
¥—ßπ’È
13.1 ´—°ª√–«—μ‘°“√°‘π¬“¢ÕߺŸâªÉ«¬„Àâ·πà„®«à“ ºŸâªÉ«¬°‘𬓰àÕπÕ“À“√
‚¥¬‡©æ“–¡◊ÈÕ‡¬Áπ μâÕ߉¡à„™à°àÕππÕπ
13.2 Õ“®æ‘®“√≥“‡æ‘Ë¡¬“ H2RA (ranitidine 150 mg À√◊Õ cimetidine
400 mg) °àÕππÕπ „π°√≥’Σ’Ë ß —¬«à“ºŸâªÉ«¬®–¡’¿“«– noctur-nal
acid breakthrough
13.3 æ‘®“√≥“‡ª≈’ˬπ™π‘¥¢Õ߬“ PPI
14. °“√μ√«®¥â«¬«‘Π’ ambulatory pH monitoring „πΣ’ËΣ’Ë “¡“√∂Σ”‰¥â
Õ“®æ‘®“√≥“Σ”μ—Èß·μà‡¡◊ËÕº≈°“√ àÕß°≈âÕßæ∫«à“ª°μ‘ ·≈–‰¡à¡’¢âÕ¡Ÿ≈
‡æ‘Ë¡‡μ‘¡À≈—ß®“°°“√ª√–‡¡‘πºŸâªÉ«¬´È”„À¡à ”À√—∫ºŸâªÉ«¬Σ’Ë„Àâ°“√√—°…“
¥â«¬ LSM ·≈–Σ∫Σ«π°“√„Àâ¬“μ“¡¢âÕ 13 ·≈â« Õ“°“√‰¡à¥’¢÷È𠧫√
æ‘®“√≥“ àߺŸâªÉ«¬μàÕ‰ª¬—ß ∂“∫—πΣ’Ë “¡“√∂Σ” ambulatory pH moni-toring
䴉
15. Mild to moderate esophagitis ∂◊Õμ“¡°“√·∫à߇°√¥ ∂â“‚¥¬«‘Π’
Savary-Miller §◊Õ grade 1-3 À√◊Õ grade A ·≈– B ¢Õß Los Ange-les
classification
16. ”À√—∫ Severe esophagitis ∂â“·∫àßμ“¡ Savary-Miller classifica-tion
®–‡Σà“°—∫ grade 4-5 À√◊Õ grade C ·≈– D ¢Õß Los Angeles
classification.
„π°√≥’Σ’Ë ß —¬ Barrettûs esophagus ®“°°“√Σ” endoscopic ex-

12. 12
·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“
‚ √ § ° √ ¥ ‰ À ≈ ¬â Õ π „πª√–‡Σ»‰Σ¬
amination §«√Σ”°“√μ—¥™‘Èπ‡π◊ÈÕ‡æ◊ËÕ àßμ√«® histology Σÿ°√“¬
17. À≈—°°“√√—°…“‡À¡◊Õπ„π¢âÕ 13 [LSM/Intensify treatment (1)] ·μà
∂⓺ŸâªÉ«¬Õ“°“√¬—߉¡à¥’¢÷Èπ¢π“¥¢Õß H2RA Õ“®‡æ‘Ë¡‡ªìπ 2 ‡Σà“‰¥â ‡™àπ
„Àâ ranitidine ‡ªìπ 300 mg ·Σπ
„π°√≥’Σ’ËºŸâªÉ«¬‡ªìπ mild À√◊Õ moderate disease ¢Õß GERD
À≈—ß°“√√—°…“®πºŸâªÉ«¬ Õ“°“√ ∫“¬¥’·≈⫺ŸâªÉ«¬Õ“®°≈—∫¡“¡’Õ“°“√Õ’°
°“√√—°…“À≈—ß®“°π’ÈÕ“®æ‘®“√≥“„À⬓‡ªìπ·∫∫ on-demand À√◊Õ in-termittent
therapy À√◊ÕÕ“®®–μâÕßæ‘®“√≥“¬“„π¢π“¥πâÕ¬Σ’Ë ÿ¥Σ’Ë®–
“¡“√∂§«∫§ÿ¡Õ“°“√ºŸâªÉ«¬‰¥â (long term maintenance therapy)
μ“¡«‘Π’ step down strategy
„π°√≥’Σ’ËºŸâªÉ«¬‡ªìπ severe esophagitis ºŸâªÉ«¬¡’‚Õ°“ Σ’Ë®–‡°‘¥
°“√°≈—∫‡ªìπ´È”‰¥â Ÿß‡¡◊ËÕÀ¬ÿ¥°“√√—°…“ ¥—ßπ—Èπ¡’·π«‚πâ¡Σ’ËμâÕß„™â¬“
‡æ◊ËÕ§«∫§ÿ¡Õ“°“√‡ªìπ√–¬–‡«≈“π“π (long term maintenance
therapy) ¥—߉¥â°≈à“«·≈â« ºŸâªÉ«¬∫“ß√“¬Õ“®μâÕß°‘𬓄π¢π“¥πâÕ¬
ÿ¥Σ’Ë “¡“√∂§«∫§ÿ¡Õ“°“√‰¥â‡ªìπ√–¬–‡«≈“À≈“¬‡¥◊Õπ®π∂÷ßÀ≈“¬ªï
”À√—∫°≈ÿà¡Σ’ˇªìπ Barrettûs esophagus ¡’·π«‚πâ¡Σ’ËμâÕß„™â¬“ PPI
‡ªìπ√–¬–‡«≈“π“π √à«¡°—∫°“√Σ” endoscopy surveillance ‡ªìπ
√–¬–‡«≈“Àà“ß°—π 1-3 ªï
(‚¥¬æ‘®“√≥“μ“¡·π«Σ“ߢÕß American College of Gastroenterology)
¢âÕ∫àß™’È„π°“√æ‘®“√≥“„Àâ°“√√—°…“¥â«¬°“√ºà“μ—¥ ¡’¥—ßπ’È
1. ºŸâªÉ«¬Σ’Ë°“√√—°…“¥â«¬¬“‰¥âº≈¥’ ·μà‰¡àμâÕß°“√°‘π¬“μàÕ‰ªÕ’°·≈–
μâÕß°“√ºà“μ—¥
2. ºŸâªÉ«¬Σ’ˉ¡à “¡“√∂ΣπμàÕ°“√„À⬓À√◊Õ¡’º≈¢â“߇§’¬ß®“°¬“À√◊Õ
‰¡à “¡“√∂°‘𬓉¥âÕ¬à“ß ¡Ë”‡ ¡Õ‡ªìπ√–¬–‡«≈“π“πÊ
3. ºŸâªÉ«¬Σ’Ë¡’ªí≠À“¥â“π‡»√…∞“π–
4. ºŸâªÉ«¬Õ“¬ÿπâÕ¬

13. Guideline for the
management of GERD
°“√√—°…“¥â«¬«‘Π’Õ◊ËπÊ ‡™àπ °“√√—°…“¥â«¬°“√„™â‡§√◊ËÕß¡◊Õ Õÿª°√≥å
摇»… À√◊Õ °“√©’¥ “√‡§¡’ ‚¥¬°“√„™â°≈âÕß àÕßΣ“ß‡¥‘πÕ“À“√ §«√
°√–Σ”„π ∂“∫—πΣ’Ë¡’§«“¡ “¡“√∂°√–Σ”‰¥â ·≈–μâÕßæ‘®“√≥“‡ªìπ
°√≥’摇»…‡ªìπ‡©æ“–√“¬‡Σà“π—Èπ
À¡“¬‡Àμÿ: ™¡√¡‚¡Π‘≈‘μ’È·Ààߪ√–‡Σ»‰Σ¬ ¿“¬„μâ ¡“§¡·æΣ¬å√–∫∫Σ“ß
‡¥‘πÕ“À“√·Ààߪ√–‡Σ»‰Σ¬ ‰¥â®—¥Σ” Statement ‡√◊ËÕß·π«Σ“ß°“√
«‘π‘®©—¬·≈–√—°…“‚√§°√¥‰À≈¬âÕ¬„πª√–‡Σ»‰Σ¬ ´÷Ëß®–¡’√“¬≈–‡Õ’¬¥√«¡
Σ—Èß¡’‡Õ° “√Õâ“ßՑ߇æ◊ËÕ„™âª√–°Õ∫°—∫ guideline „πÀπ—ß ◊Õ‡≈à¡π’È ·≈–‰¥â àßμàÕ
‰ª¬—ß√“™«‘Σ¬“≈—¬Õ“¬ÿ√·æΣ¬å·Ààߪ√–‡Σ»‰Σ¬, °√–Σ√«ß “Π“√≥ ÿ¢·≈–
∂“∫—πæ—≤π“·≈–√—∫√Õߧÿ≥¿“æ‚√ß欓∫“≈ (æ√æ) ‡æ◊ËÕ‡º¬·æ√àμàÕ‰ª
Σà“π “¡“√∂À“√“¬≈–‡Õ’¬¥‰¥â„π®ÿ≈ “√ ¡“§¡·æΣ¬å√–∫∫Σ“ß‡¥‘πÕ“À“√
·Ààߪ√–‡Σ»‰Σ¬, “√√“™«‘Σ¬“≈—¬Õ“¬ÿ√·æΣ¬å·Ààߪ√–‡Σ»‰Σ¬ ·≈–
www.thaigastro.org
13

14. 14
·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“
‚ √ § ° √ ¥ ‰ À ≈ ¬â Õ π „πª√–‡Σ»‰Σ¬
·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“‚√§°√¥‰À≈¬âÕπ„πΣ“√°·≈–‡¥Á°
Infantile GER §◊Õ ¿“«– GER Σ’Ë‡°‘¥¢÷Èπ„πΣ“√°®–‡√‘Ë¡¡’Õ“°“√
μ—Èß·μàÕ“¬ÿ 1-3 ‡¥◊Õπ ‚¥¬®–¡“¥â«¬Õ“°“√¢¬âÕπ (regurgitation) ·≈–Õ“‡®’¬π
(vomiting) à«π„À≠à‡ªìπ uncomplicated GER ·≈–¡—°®–À“¬‡Õ߉¥â‡¡◊ËÕ
Õ“¬ÿ 12-18 ‡¥◊Õπ ·μà¡’ºŸâªÉ«¬∫“ß√“¬Σ’ËÕ“®‡°‘¥ GERD ‰¥â
Adult type GER §◊Õ ¿“«– GERD Σ’Ë‡°‘¥¢÷Èπ„π‡¥Á°‚μ‚¥¬¡’
Õ“°“√‡√‘Ë¡μâπ‡¡◊ËÕÕ“¬ÿ¡“°°«à“ 1 ªï ¡—°®–‡ªìπ Ê À“¬ Ê
·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“‚√§°√¥‰À≈¬âÕπ·∫à߇ªìπ°≈ÿà¡μ“¡Õ“°“√
À√◊Õ¿“«–·Σ√°´âÕπ¥—ßπ’È
1. Σ“√°Σ’Ë¡’Õ“°“√¢¬âÕπ (regurgitation)·≈–/À√◊ÕÕ“‡®’¬π
2. Σ“√°·≈–‡¥Á°Σ’Ë¡’Õ“°“√¢¬âÕπ(regurgitation)·≈–/À√◊Õ
Õ“‡®’¬π√à«¡°—∫Õ“°“√¢ÕßGERD
3. GERD related respiratory diseases 䴉ᡈ apparent life-threatening
event-ALTE , persistent asthma, recurrent
pneumonia ·≈–§«“¡º‘¥ª°μ‘Σ“ß‡¥‘πÀ“¬„®μÕπ∫π
4. GERD „π‡¥Á°Σ’Ë¡’ªí≠À“Σ“ß ¡Õß
À¡“¬‡Àμÿ: ‡¥Á°‚μΣ’Ë¡’ heartburn „™â·π«Σ“ß°“√√—°…“ GERD „πºŸâ„À≠à

15. Guideline for the
management of GERD
·ºπ¿Ÿ¡‘ 1 : ·π«Σ“ß°“√ª√–‡¡‘π·≈–√—°…“Σ“√°Σ’Ë¡’Õ“°“√¢¬âÕπ (regurgi-tation)
15
·≈–/À√◊ÕÕ“‡®’¬π
Investigate for
other diagnosis
Complications of GER
No improvement
1
Resolve by 18
months of age
Observe for GERD
Physiologic GER
Infant with regurgitation and vomiting
Alarming symptoms of other diseases
Improve
GER GERD
ë Reassure
ë LSM 2-4 wks
yes
No
No yes
2
3
4
5 8
6
7
8
Consider 8
hypoallergenic
formula

16. 16
·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“
‚ √ § ° √ ¥ ‰ À ≈ ¬â Õ π „πª√–‡Σ»‰Σ¬
§”ÕΠ‘∫“¬·ºπ¿Ÿ¡‘ 1
1. ¿“«–°√¥‰À≈¬âÕπ (gastroesophageal reflux-GER) æ∫‰¥â∫àÕ¬„πΣ“√°
´÷Ëß à«π„À≠à‰¡à°àÕ„À⇰‘¥‚√§À√◊Õ¿“«–·Σ√°´âÕπ ·≈–¡—°®–‰¡àμâÕß°“√
√—°…“ ¿“«–°√¥‰À≈¬âÕπΣ’Ë‡°‘¥¿“«–·Σ√°´âÕπ ‡√’¬°«à“ ‚√§°√¥‰À≈¬âÕπ
(gastroesophageal reflux disease-GERD)
2. Õ“°“√‡μ◊Õπ (alarming symptoms) Σ’Ë ”§—≠„πΣ“√°Σ’ËÕ“‡®’¬π´÷Ëß∫àß™’È
«à“ “‡ÀμÿÕ“®¡‘„™à GER Õ“®¡’ “‡Àμÿ®“°‚√§Õ◊Ëπ ‰¥â·°à Õ“‡®’¬π¡’πÈ”¥’
ªπ Õ“‡®’¬πæÿàß Õ“‡®’¬π√ÿπ·√ß Õ“‡®’¬π‡√‘Ë¡μâπÕ“¬ÿ‡°‘π 6 ‡¥◊Õπ ‡≈◊Õ¥
ÕÕ°„πΣ“ß‡¥‘πÕ“À“√ °¥‡®Á∫Σ’ËÀπâ“ΣâÕß ΣâÕßÕ◊¥ §≈”‰¥â°âÕπΣ’ËΣâÕß ‰¢â
μ—∫¡â“¡‚μ °√–À¡àÕ¡‚ªÉßμ÷ß »’√…–‡≈Á°À√◊Õ‚μº‘¥ª°μ‘ ™—° μ√«®æ∫
§«“¡º‘¥ª°μ‘√–∫∫ª√– “Σ
3. ¡’ alarming symptoms „Àâμ√«®§âπ‡æ‘Ë¡‡μ‘¡‡æ◊ËÕ«‘π‘®©—¬·¬°‚√§Õ◊Ëπ
ÕÕ°‰ª‚¥¬¡’·π«Σ“ßμ“¡μ“√“ßΣ’Ë 1
4. ‰¡à¡’ alarming symptoms „Àâª√–‡¡‘π«à“¡’¿“«–·Σ√°´âÕπ¢Õß GER
À√◊Õ‰¡à (μ“√“ßΣ’Ë 2)
5 Σ“√°Σ’Ë¡’Õ“°“√¢¬âÕπÀ√◊ÕÕ“‡®’¬π‚¥¬‰¡à¡’¿“«–·Σ√°´âÕπ·≈–‰¡à¡’
Õ“°“√·≈–Õ“°“√· ¥ßΣ’Ë∫àß™’È∂÷ß‚√§Õ◊ËπÊ “¡“√∂„Àâ°“√«‘π‘®©—¬ GER ‚¥¬
‰¡à®”‡ªìπμâÕß àßμ√«®«‘π‘®©—¬‡æ‘Ë¡‡μ‘¡ °“√√—°…“§◊Õ °“√ reassurance
æàÕ·¡à √à«¡°—∫ life-style modification (LSM)
6. Life-style modification (LSM) 䴉ᡈ
6.1 Feeding technique „ÀâÕ“À“√ª√‘¡“≥πâÕ¬ÊμàÕ¡◊ÈÕ ·μà„Àâ
®”π«π§√—Èß∫àÕ¬¢÷Èπ
6.2 Thickening formula ‚¥¬„™âπ¡ ”‡√Á®√ŸªΣ’˺ ¡ “√‡æ‘Ë¡
§«“¡Àπ◊¥ À√◊Õ‡μ√’¬¡‡Õß ‡™àπ º ¡ rice cereal Σ”„Àâ
Õ“°“√·À«–π¡·≈–Õ“‡®’¬π„πΣ“√°¥’¢÷Èπ
6.3 Hypoallergenic formula (䴉ᡈ extensively hydrolysed

17. Guideline for the
management of GERD
formula) À√◊Õ soy formula „™â„π°√≥’Σ’Ë ß —¬ cowûs milk
protein allergy ´÷ËßÕ“®¡“¥â«¬Õ“°“√¢¬âÕπÀ√◊ÕÕ“‡®’¬π
6.4 Positioning °“√πÕπ§«Ë”®–™à«¬≈¥°“√‡°‘¥ GER ·μ৫√
√–¡—¥√–«—߇π◊ËÕß®“°„πμà“ߪ√–‡Σ»æ∫«à“°“√πÕπ§«Ë”¡’
‚Õ°“ ‡°‘¥ sudden infant death syndrome Õ“®„ÀâπÕπ
Σà“μ–·§ß´â“¬·Σπ °“√®—∫Σ“√°Õ¬Ÿà„πΣà“μ—Èßμ√ß (upright) À≈—ß
°‘ππ¡‡ªìπ‡«≈“ª√–¡“≥ 15-20 π“Σ’·≈–À≈’°‡≈’ˬ߰“√°¥
∫√‘‡«≥ΣâÕß®–™à«¬≈¥Õ“°“√Õ“‡®’¬π
7. À“°Õ“°“√¥’¢÷È𠧫√μ‘¥μ“¡ºŸâªÉ«¬‡ªìπ√–¬–Ê ®π°«à“Õ“°“√®–À“¬‰ª
‡¥Á°Σ’ËÕ“°“√À“¬¿“¬„πÕ“¬ÿ 18 ‡¥◊Õπ ‚¥¬‰¡à¡’¿“«–·Σ√°´âÕπ∂◊Õ«à“
‡ªìπ physiologic GER
8. „π√“¬Σ’ˉ¡à¥’¢÷È𠧫√μ‘¥μ“¡¥Ÿ„°≈♑¥«à“¡’¿“«–·Σ√°´âÕπ (GERD) À√◊Õ
‰¡à ‡¥Á°°≈ÿà¡π’È à«πÀπ÷ËßÕ“®‡ªìπ cowûs milk protein allergy æ‘®“√≥“
≈Õß„Àâ hypoallergenic formula 1-2 —ª¥“Àå·≈–¥Ÿ°“√μÕ∫ πÕß À“°
¥’¢÷Èπ™—¥‡®π πà“®–‡ªìπ cowûs milk protein allergy ∂⓺ŸâªÉ«¬¡’¿“«–
·Σ√°´âÕπ¢Õß GER À√◊Õ„Àâ°“√√—°…“‚¥¬ LSM À√◊Õ‰¥â√—∫ hypoallergenic
formula ·≈⫉¡à¥’¢÷Èπ„À⥟·ºπ¿Ÿ¡‘Σ’Ë 2
17

18. 18
·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“
‚ √ § ° √ ¥ ‰ À ≈ ¬â Õ π „πª√–‡Σ»‰Σ¬
·ºπ¿Ÿ¡‘ 2: ·π«Σ“ß°“√ª√–‡¡‘π·≈–√—°…“Σ“√°·≈–‡¥Á°Σ’Ë¡’Õ“°“√¢¬âÕπ
(regurgitation)·≈–/À√◊Õ Õ“‡®’¬π√à«¡°—∫Õ“°“√¢Õß GERD
Regurgitation/ vomiting with GERD symptoms
Suspected
of CMPA
Trial of
hypoallergenic
formula
Suspected
of esophagitis
Poor weight gain
despite of proper feeding
ë LSM
ë Acid suppression +
prokinetic Rx 2-4 wks
ë GI contrast study
ë Screening labs
Normal Abnormal
LSM 1-2 wks Improve Continue Rx
until resolved
Prokinetic and/or acid
suppression Rx 2-4 wks
Response
Continue Rx 8-12
wks or until 9-12
months of age
No response
Consult Ped GI
Upper endoscopy
GERD Other diagnosis
Optimized medical Rx Rx accordingly
1
2 3
5
6
4
Symptom persist

19. Guideline for the
management of GERD
19
§”ÕΠ‘∫“¬·ºπ¿Ÿ¡‘Σ’Ë 2
1. Σ“√°·≈–‡¥Á°Σ’Ë¡’¢¬âÕπÀ√◊ÕÕ“‡®’¬π·≈–¡’Õ“°“√∫àß™’È∂÷ß¿“«–
·Σ√°´âÕπ¢Õß GER (μ“√“ßΣ’Ë 2)
2. ‡¥Á°Σ’ˇªìπ cowûs milk protein allergy Õ“®¡“¥â«¬Õ“°“√·∫∫ GERD
À“° ß —¬¿“«–π’ȧ«√≈Õß„Àâ hypoallergenic formula (‰¥â·°à exten-sively
hydrolysed formula) À√◊Õ soy formula 1-2 —ª¥“Àå·≈–¥Ÿ
°“√μÕ∫ πÕß
3. À“°ºŸâªÉ«¬¡’Õ“°“√ ß —¬ esophagitis ‡™àπ Σ“√°Σ’Ë√âÕß°«πº‘¥ª°μ‘
ªØ‘‡ Π°“√°‘πÕ“À“√ À≈—ß·Õàπ‡°√Áß (back arching) ´’¥ ‡¥Á°‚μÕ“®¡’
heartburn ‡ªìπμâπ °“√√—°…“§◊Õ „À⬓ acid suppression (μ“√“ßΣ’Ë
3) ‡ªìπÀ≈—° Õ“®æ‘®“√≥“„Àâ prokinetic drug √à«¡¥â«¬ °“√„À⬓„Àâ
Σ”§«∫§Ÿà‰ª°—∫ LSM
4. ºŸâªÉ«¬Σ“√°·≈–‡¥Á°Σ’Ë¡’Õ“°“√Õ“‡®’¬π√à«¡°—∫πÈ”Àπ—°¢÷Èπ™â“ „π¢≥–Σ’Ë
Õ“À“√Σ’Ë„Àâ¡’ª√‘¡“≥‡æ’¬ßæÕ·≈–‰¡à¡’§«“¡º‘¥ª°μ‘Σ’Ë∫àß™’È∂÷ß‚√§√–∫∫
Õ◊ËπÊ (μ“√“ßΣ’Ë 1) ºŸâªÉ«¬§«√‰¥â√—∫°“√μ√«®Σ“ß√—ß ’«‘Σ¬“‚¥¬°“√Σ” GI
contrast study ‡æ◊ËÕ·¬°¿“«–Σ“ß‡¥‘πÕ“°“√Õÿ¥°—ÈπÕÕ°‰ª „πΣ“√°
§«√ à߇≈◊Õ¥μ√«®Σ“ßÀâÕߪؑ∫—μ‘°“√‡∫◊ÈÕßμâπ‡æ◊ËÕ·¬° “‡ÀμÿÕ◊ËπÊ‚¥¬
‡©æ“–Σ“ß‡¡μ“∫Õ≈‘§ ‡™àπ CBC, electrolytes, blood sugar, BUN,
Cr, ammonia, urinalysis ‡ªìπμâπ
5. À“°º≈°“√μ√«® GI contrast study ·≈–°“√μ√«®Σ“ßÀâÕߪؑ∫—μ‘
°“√‡∫◊ÈÕßμâπ¥—ß°≈à“«¢â“ßμâπ‰¡àæ∫§«“¡º‘¥ª°μ‘„¥Ê „Àâ°“√√—°…“‚¥¬ life
style modification (LSM) ¥—ß°≈à“«„π§”ÕΠ‘∫“¬·ºπ¿Ÿ¡‘Σ’Ë 1 À“°
‡ªìπ‡¥Á°‚μ„ÀâªØ‘∫—μ‘¥—ßπ’È
o πÕπμ–·§ß´â“¬·≈–À—« Ÿß
o §«√À≈’°‡≈’ˬßÕ“À“√‡ºÁ¥À√◊Õ√ ®—¥ Õ“À“√¡—π πȔ՗¥≈¡ ™ÁÕ°‚°·≈μ
°“·ø ·Õ≈°ÕOEÕ≈å

20. 20
·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“
‚ √ § ° √ ¥ ‰ À ≈ ¬â Õ π „πª√–‡Σ»‰Σ¬
o §«√§«∫§ÿ¡πÈ”Àπ—°‰¡à„ÀâÕâ«π‡°‘π‰ª
o ‰¡à§«√°‘πÕ“À“√°àÕππÕπ
o ‰¡à§«√°‘πÕ“À“√ª√‘¡“≥¡“°‡°‘π‰ª„π·μà≈–¡◊ÈÕ
À“°ºŸâªÉ«¬‰¡à¥’¢÷Èπ„π√–¬–‡«≈“ 1-2 —ª¥“Àå §«√√—°…“¥â«¬¬“‚¥¬
„À⬓ prokinetic (μ“√“ßΣ’Ë 3) Õ“®æ‘®“√≥“„À⬓°≈ÿà¡ acid suppres-sion
(μ“√“ßΣ’Ë 3) √à«¡¥â«¬ §«√„Àâ°“√√—°…“¥â«¬¬“‡ªìπ‡«≈“ 2-4 —ª¥“Àå
·≈⫪√–‡¡‘π°“√μÕ∫ πÕß „πºŸâªÉ«¬Σ’Ë¡’Õ“°“√√ÿπ·√ßÕ“®æ‘®“√≥“
√—°…“¥â«¬¬“‰ªæ√âÕ¡Ê °—∫ LSM ‰¡à®”‡ªìπμâÕß√ÕÕ’° 1-2 —ª¥“Àå
6. ‡¡◊ËÕ√—°…“¥â«¬¬“‡ªìπ‡«≈“ 2-4 —ª¥“Àå ¬—߉¡à‰¥âº≈§«√ àßμàÕ°ÿ¡“√
·æΣ¬å√–∫∫Σ“ß‡¥‘πÕ“À“√ª√–‡¡‘πºŸâªÉ«¬μàÕ‰ª ´÷Ëß®”‡ªìπμâÕßΣ” up-per
endoscopy ·≈– biopsy ‡æ◊ËÕΣ”°“√«‘π‘®©—¬‚√§Õ◊ËπÊ Σ’Ë¡’
Õ“°“√§≈⓬°—∫ GERD ‡™àπ esoinophilic esophagitis, cow milk
protein allergy, peptic ulcer disease ‡ªìπμâπ √«¡Σ—Èßæ‘®“√≥“
°“√μ√«®Õ◊ËπÊ ‡™àπ 24- h esophageal pH monitoring ‡ªìπμâπ À“°
º≈°“√μ√«®æ∫«à“¡’ GERD §«√√—°…“‚¥¬°“√„Àâ¬“Σ’Ë¡’ª√– ‘ΣΠ‘¿“楒
¢÷Èπ·≈–æ‘®“√≥“„Àâ¢π“¥¬“ Ÿß¢÷Èπ (μ“√“ßΣ’Ë 3)

21. Guideline for the
management of GERD
·ºπ¿Ÿ¡‘ 3 : ·π«Σ“ß°“√ª√–‡¡‘π·≈–√—°…“Σ“√°·≈–‡¥Á°Σ’Ë ß —¬ GERD
Patient suspected of GERD related respiratory
diseases after excluding other causes
Esophageal symptoms of
2
No
ë Barium swallow (swallowing as-sessment)
ë Consult Pediatric pulmonologist
ë Consult Pediatric GI
ë Esophageal pH monitoring
ë Consider other investigations eg.
scintigraphy, lipid laden mac-rophage,
21
related respiratory diseases
GERD
Yes
ë LSM
ë Acid suppression +
prokinetic 2-4 wks
Yes
No
§”ÕΠ‘∫“¬·ºπ¿Ÿ¡‘Σ’Ë 3
or UGIS
etc
Clinical
Improvement ?
Yes
1
Continue Rx for
3-6 months
Relapse after
stop
No
Observation
1. ∂â“¡’Õ“°“√ typical GERD ‰¥â·°à ¢¬âÕπ Õ“‡®’¬π heartburn √à«¡¥â«¬
„Àâ≈Õß√—°…“·∫∫ GERD ‰ª°àÕπ ∂â“μÕ∫ πÕߥ’„Àâ√—°…“μàÕπ“π 3-6
‡¥◊Õπ ∂Ⓣ¡àμÕ∫ πÕßÀ√◊Õ°≈—∫¡“‡ªìπ„À¡àÀ≈—ßÀ¬ÿ¥°“√√—°…“ „Àâ
ªØ‘∫—μ‘μ“¡¢âÕ 2
2. ∂Ⓣ¡à¡’Õ“°“√ typical GERD §«√ àßμ√«®‡æ‘Ë¡‡μ‘¡‡æ◊ËÕ«‘π‘®©—¬ GERD
´÷Ëߢ÷Èπ°—∫§«“¡ “¡“√∂¢Õß·μà≈–‚√ß欓∫“≈

22. 22
·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“
‚ √ § ° √ ¥ ‰ À ≈ ¬â Õ π „πª√–‡Σ»‰Σ¬
·ºπ¿Ÿ¡‘Σ’Ë 4: ·π«Σ“ß°“√ª√–‡¡‘π·≈–√—°…“ GERD „π‡¥Á°Σ’Ë¡’ªí≠À“Σ“ß
¡ÕßΣ’Ë„ à PEG À√◊Õ„ à nasogastric tube ·≈–/À√◊Õ
«“ß·ºπΣ” PEG
Neurologically impaired children with feeding difficulty
ë GI contrast study
ë Other investigations Vomiting Occupation
therapist
Atypical
symptoms of
GERD
ë Slowly drip in 1-2 hr/feeding
ë LSM
Continue Rx Response?
Trial of prokinetic and/or acid
suppression Rx 2-4 wk
Response
LSM + acid suppression
Rx + prokinetic 2-4 wks
ë Consult Ped GI
ë Investigations eg.
pH monitoring, upper
endoscopy, etc
Recurrent symptoms
Continue Rx ë Consult Ped GI
ë Upper endoscopy
No
esophagitis
Erosive
esophagitis
No GERD
Further investigations
Acid suppression Rx and
prokinetic 6-8 wks
No response
Fundoplication
Continue Rx
for 3-6 mo
Response
No
No
Yes
1
2
5
Yes No 3
4
Yes

23. Guideline for the
management of GERD
23
§”ÕΠ‘∫“¬·ºπ¿Ÿ¡‘Σ’Ë 4
1. ‡¥Á°Σ’Ë°≈◊πÕ“À“√‡Õ߉¡à‰¥â §«√‰¥â√—∫°“√Σ” gastrostomy „π√æ.Σ’Ë
“¡“√∂Σ” percutaneous endoscopic gastrostomy (PEG) ‰¥â
„Àâ‡≈◊Õ°Σ” PEG ‡ªìπÕ—π¥—∫·√°°àÕπ ·μà„πºŸâªÉ«¬Σ’Ë«“ß·ºπ®–Σ” sur-gical
gastrostomy Õ¬Ÿà·≈â«À“°¡’Õ“°“√ ß —¬ GERD ·≈–‰¥â√—∫
°“√μ√«®¬◊π¬—π«‘π‘®©—¬«à“¡’ GERD §«√Σ” surgical gastrostomy
·≈– fundoplication ‰ªæ√âÕ¡°—π
2. ∂â“¡’Õ“°“√Õ“‡®’¬π „Àâμ√«®À“ “‡ÀμÿÕ◊ËπÊ·≈–„Àâ°“√√—°…“μ“¡ “‡Àμÿ
∂â“μ√«®·≈⫪°μ‘„Àâ≈Õß„ÀâÕ“À“√Σ“ß “¬Õ¬à“ß™â“ Ê √à«¡°—∫ LSM ∂â“
‰¡à¥’¢÷Èπ„Àâ°“√√—°…“¥â«¬¬“√—°…“ GERD
3. ‡¡◊ËÕ√—°…“·≈⫉¡à‰¥âº≈ μâÕßΣ” upper endoscopy ∂â“æ∫«à“‰¡à¡’ esoph-agitis
„ÀâΣ”ºà“μ—¥ fundoplication ·μà∂â“æ∫«à“¡’ erosive esophagitis
„Àâ≈Õß√—°…“¥â«¬¬“ acid suppression „Àâ‡μÁ¡Σ’ËÕ’°§√—Èß√à«¡°—∫
prokinetic À“°√—°…“¥â«¬¬“‰¡à¥’¢÷È𠧫√Σ”ºà“μ—¥ fundoplication
æ‘®“√≥“Σ”√à«¡°—∫ surgical gastrostomy („π√“¬Σ’ˬ—ß¡‘‰¥âΣ” PEG)
4. ºŸâªÉ«¬¡’Õ“°“√ atypical GERD Õ“®≈Õß„Àâ°“√√—°…“ GERD ‰ª‡≈¬
À√◊Õ àßμàÕ‡æ◊ËÕΣ”°“√μ√«®«‘π‘®©—¬ GERD À“°√—°…“¥â«¬¬“·≈â«¥’¢÷Èπ
„Àâ√—°…“μàÕπ“π 3-6 ‡¥◊Õπ ∂Ⓣ¡à¥’¢÷Èπ§«√ àßμàÕ‡æ◊ËÕμ√«®«‘π‘®©—¬ GERD
5. ‡¡◊ËÕ°“√μ√«®«‘π‘®©—¬¬◊π¬—π GERD Õ“®≈Õß„Àâ°“√√—°…“¥â«¬¬“ 6-8
—ª¥“ÀåÀ√◊ÕÕ“®Σ”°“√ºà“μ—¥ fundoplication ‰ª‡≈¬ À“°√—°…“¥â«¬
¬“‰¡à¥’¢÷Èπ§«√Σ”ºà“μ—¥ fundoplication æ‘®“√≥“Σ”√à«¡°—∫ surgical
gastrostomy („π√“¬Σ’ˬ—ß¡‘‰¥âΣ” PEG)

24. 24
·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“
‚ √ § ° √ ¥ ‰ À ≈ ¬â Õ π „πª√–‡Σ»‰Σ¬
μ“√“ßΣ’Ë 1. Õ“°“√·≈–Õ“°“√· ¥ß·≈–°“√«‘π‘®©—¬·¬°‚√§„πΣ“√°·≈–
‡¥Á°Σ’Ë¡“¥â«¬Õ“‡®’¬π
°≈ÿà¡‚√§ Õ“°“√·≈–Õ“°“√· ¥ßΣ’Ë ”§—≠ ‚√§ Investigation
GI - Projectile vomiting with Pyloric stenosis Abdominal US, UGIS
obstruction epigastric mass, FTT
- Bilious vomiting, abdominal Small bowel obstruction, UGIS/LGIS
distention, mass malrotation with
intermittent volvulus
- Abdominal distention/ Hirschsprungûs disease Barium enema
constipation
GI disorders - Hematemesis/hematochezia, Gastritis/duodenitis Upper endoscopy
abdominal pain
- Hematemesis/hematochezia, CMPA, food allergy Food challenge
edema, anemia, skin rash, FTT
- Hematemesis, dysphagia, Eosinophilic esophagitis Upper endosopy
feeding refusal
- Abdominal distension, Gastroparesis Gastric emptying study
early satiety
- Dysphagia Achalasia Barium swallowing
Neurologic - Bulging anterior fontanelle, Hydrocephalus Neuroimaging study
conditions macrocephaly, seizure, Intracranial mass
weakness, signs of
increased ICP
Infection - Fever, lethargy Meningitis/sepsis Septic work up
- Dysuria Urinary tract infection Urine exam and culture
Metabolic - Lethargy, hepatomegaly Urea cycle defect Metabolic work up
and - Abnormal genitalia, CAH
endocrine hyperpigmentation
disorders - Hepatosplenomegaly, jaundice, Galactosemia
cataract
- Septic-like episode, metabolic Organic acidemia
acidosis
Toxic History of exposure or ingestion Lead, iron, vitamin A or D Toxicology work up
substances
FTT=failure to thrive, CMPA=cowûs milk protein allergy, US=ultrasonography, UGIS=upper
GI study, LGIS=Long GI study, ICP=intracranial pressure, CAH=congenital adrenal hyper-plasia

25. Guideline for the
management of GERD
25
μ“√“ßΣ’Ë 2 ¿“«–·Σ√°´âÕπ¢Õß GER (GERD)
1. √–∫∫Σ“ß‡¥‘πÕ“À“√
Õ“‡®’¬π‡ªìπ‡≈◊Õ¥ ´’¥ À≈Õ¥Õ“À“√Õ—°‡ ∫
persistent irritability À≈Õ¥Õ“À“√μ’∫ (stricture)
ªØ‘‡ ΠÕ“À“√ Barrettûs esophagus
°≈◊π≈”∫“° °≈◊π·≈⫇®Á∫
heartburn ª«¥ΣâÕß∫√‘‡«≥≈‘Èπªïò
2. √–∫∫Σ“ß‡¥‘πÀ“¬„®
Asthma À√◊Õ recurrent wheezing Recurrent pneumonia / bronchitis
Stridor Hoarseness
Apnea À√◊Õ apparent life-threatening event (ALTE)
3. √–∫∫Õ◊ËπÊ
πÈ”Àπ—°¢÷Èπ™â“ ‡≈’Ȭ߉¡à‚μ
Abnormal posture (Sandifer syndrome)

26. 26
·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“
‚ √ § ° √ ¥ ‰ À ≈ ¬â Õ π „πª√–‡Σ»‰Σ¬
μ“√“ßΣ’Ë 3 ¬“Σ’Ë„™â„π°“√√—°…“ GERD „π‡¥Á°
™π‘¥¢Õ߬“ ¢π“¥¬“ ¢π“¥¬“ Ÿß ÿ¥
ë Prokinetics
- Metoclopramide 0.1 ¡°./°°./§√—Èß 5 ¡°. «—π≈– 3-4 §√—Èß
«—π≈– 3-4 §√—Èß
- Domperidone 0.3-0.6 ¡°./°°./§√—Èß 10 ¡°. «—π≈– 3-4 §√—Èß
«—π≈– 3-4 §√—Èß
- Cisapride* 0.2 ¡°./°°./§√—Èß 10 ¡°. «—π≈– 3-4 §√—Èß
«—π≈– 3-4§√—Èß
ë H2 receptor
antagonists (H2RA)
- Cimetidine 40 ¡°./°°./«—π 800-1200 ¡°.
·∫àß«—π≈– 3 §√—Èß «—π≈– 2-3 §√—Èß
- Ranitidine 5-10 ¡°./°°./«—π
·∫àß«—π≈– 2 À√◊Õ 3 §√—Èß 300 ¡°. «—π≈– 2 §√—Èß
- Famotidine 1 ¡°./°°./«—π 20 ¡°. «—π≈– 2 §√—Èß
·∫àß«—π≈– 2 §√—Èß
ë Proton pump
inhibitors
- Omeprazole 1-2 ¡°./°°./«—π 40 ¡°. «—π≈– 1-2 §√—Èß
„Àâ«—π≈– 1 À√◊Õ 2 §√—Èß
Õ“®‡æ‘Ë¡‰¥â∂÷ß
3.5 ¡°./°°./«—π
- Lansoprazole 0.7-1.4 ¡°./°°./«—π 30 ¡°. «—π≈– 1-2 §√—Èß
„Àâ«—π≈– 1-2 §√—Èß
À√◊Õ 15 ¡°.«—π≈– 1 §√—Èß
(ππ< 30 °°.), 30 ¡°.
«—π≈– 1 §√—Èß
(ππ> 30 °°.)

27. Guideline for the
management of GERD
À¡“¬‡Àμÿ* Àâ“¡„™â„πºŸâªÉ«¬Σ’Ë¡’ QT prolong Àâ“¡„™â√à«¡°—∫¬“°≈ÿà¡
macrolides, azole antifungus, protease inhibitor §«√À≈’°‡≈’ˬ߰“√
„™â„πΣ“√°‡°‘¥°àÕπ°”Àπ¥ §«√„™âÕ¬à“ß√–¡—¥√–«—ß„πºŸâªÉ«¬Σ’Ë¡’‚√§À—«„®
ºŸâªÉ«¬Σ’Ë¡’§«“¡º‘¥ª°μ‘¢Õß “√Õ’‡≈Á§‚Σ√‰≈Σå ºŸâªÉ«¬‚√§μ—∫·≈–‰μ
27

28. 28
·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“
‚ √ § ° √ ¥ ‰ À ≈ ¬â Õ π „πª√–‡Σ»‰Σ¬
√“¬π“¡ºŸâ‡¢â“ª√–™ÿ¡ —¡¡π“
Consensus for Clinical Practice Guideline „πºŸâ„À≠à
§√—ÈßΣ’Ë 1
«—πΣ’Ë 14-15 ¡‘∂ÿπ“¬π 2546
≥ ‚√ß·√¡ Anantara ®.‡æ™√∫ÿ√’
§√—ÈßΣ’Ë 2
«—πΣ’Ë 24-25 ¡°√“§¡ 2547
≥ ‚√ß·√¡ Kanary Bay ®.√–¬Õß
πæ.‡°√’¬ß‰°√ Õ—§√«ß»å √æ. ¡‘쑇«™ °√ÿ߇Σæoe
πæ.·®à¡»—°¥‘Ï ‰™¬§ÿ≥“ √æ.»‘√‘√“™ °√ÿ߇Σæ
æ≠.‚©¡»√’ ‚¶…‘μ™—¬«—≤πå √æ.√“¡“Π‘∫¥’ °√ÿ߇Σæoe
πæ.μ«ß‡°’¬√μ‘ ‡®’¬¡Õÿ¥¡æß…å √æ.ª√“®’π∫ÿ√’ ª√“®’π∫ÿ√’
πæ.∂πÕ¡ ®‘« ◊∫æß…å √æ. «√√§åª√–™“√—°…å π§√ «√√§å
πæ.ΣÕߥ’ ™—¬æ“π‘™ √æ. ¡‘쑇«™ °√ÿ߇Σæoe
πæ.Ππ“ Õ—ß ÿ«√√—ß…’ √æ.»‘√‘√“™ °√ÿ߇Σæoe
πæ.Π‡π» ®—¥«—≤π°ÿ≈ √æ. ¡‡¥Á®æ√–∫√¡√“™‡Σ«’
≥ »√’√“™“ ™≈∫ÿ√’
πæ.Π’√–æß…å ÿ¢‰æ»“≈ √æ. ߢ≈“π§√‘πΣ√å ߢ≈“
πæ.∫—≠™“ ‚Õ«“ΣÓ√æ√ √æ. ߢ≈“π§√‘πΣ√å ߢ≈“
æ≠.ª≥‘Π“π —πμ‘¿«—ߧå √æ.π§√ «√√§å π§√ «√√§å
πæ.æ‘π‘® °ÿ≈≈–«≥‘™¬å √æ.®ÿÓ≈ß°√≥å °√ÿ߇Σæoe
πæ.æ‘æ—≤πå ®‘√π—¬√“¥ÿ≈ √æ.æ–‡¬“ æ–‡¬“
πæ.æŸπΣ√—æ¬å «ß»å ÿ√‡°’¬√μ‘ √æ.»‘√‘√“™ °√ÿ߇Σæoe
πæ.¿—Σ√“¬ÿ ÕÕª√–¬Ÿ√ √æ.æ√–ª°‡°≈â“ ®—πΣ∫ÿ√’

29. Guideline for the
management of GERD
πæ.¡°√‡Σæ ‡Σæ°“≠®π“ √æ.√—™¥“-Σà“æ√– °√ÿ߇Σæoe
πæ.¬»æ√ ‚ ¿≥Ππ–»‘√‘ √æ.‚Õ‡«Õ√å∫ÿä§ ‡™’¬ß√“¬
æ≠.√—μπ“ ∫ÿ≠»‘√‘®—πΣ√å √æ.«™‘√欓∫“≈ °√ÿ߇Σæoe
πæ.√“«‘π ‚´π’Ë √æ.»Ÿπ¬å≈”ª“ß ≈”ª“ß
æ≠.«—≤π“ ÿ¢’‰æ»“≈‡®√‘≠ √æ.»√’π§√‘πΣ√å ¢Õπ·°àπ
æΣ.πæ.«“π‘™ ªî¬π‘√—π¥√å √æ.æ√–¡ß°ÿ؇°≈â“ °√ÿ߇Σæoe
πÕ.πæ.«‘≠êŸ ®—πΣ√ ÿπΣ√°ÿ≈ √æ.¿Ÿ¡‘æ≈Õ¥ÿ≈‡¥™ °√ÿ߇Σæoe
πæ.«‘ΣŸ√ ™‘π «à“ß«—≤π°ÿ≈ √æ.»‘√‘√“™ °√ÿ߇Σæoe
πæ.«ÿ≤‘™—¬ ÿΣΠ‘∂«‘≈ √æ.æ√–¡ß°ÿ؇°≈â“ °√ÿ߇Σæoe
πæ.»μ«√√… ΣÕß «— ¥‘Ï √æ.¡À“√“™π§√‡™’¬ß„À¡à ‡™’¬ß„À¡à
æ≠.»‘√‘æ√ ™’‡®√‘≠ √æ.«‘™—¬¬ÿΣΠ °√ÿ߇Σæoe
πæ.»ÿ¿™—¬ »√’»‘√‘√ÿàß √æ.æ≠“‰Σ-»√’√“™“ ™≈∫ÿ√’
πæ. ¡™“¬ ≈’≈“°ÿ»≈«ß»å √æ.»‘√‘√“™ °√ÿ߇Σæoe
æ≠. ”√“≠ °≈—Ëπ·æΣ¬å°‘® √æ.°≈“ß °√ÿ߇Σæoe
πæ. ‘π Õπÿ√“…Ø√å √æ.∫”√ÿß√“…Ø√å °√ÿ߇Σæoe
πæ. ÿ‡®μπå ‡≈‘»‡Õπ°«—≤π“ √æ.ÀπÕߧ“¬ ÀπÕߧ“¬
πæ. ÿ‡Σæ °≈™“≠«‘Σ¬å √æ.®ÿÓ≈ß°√≥å °√ÿ߇Σæoe
πæ. ÿæ®πå æß»åª√– ∫™—¬ √æ.»‘√‘√“™ °√ÿ߇Σæoe
æÕ.πæ. ÿ√æ≈ ÿ√“ߧå»√’√—∞ √æ.æ√–¡ß°ÿƇ°≈â“ °√ÿ߇Σæoe
πæ. ÿ√‘¬– ®—°°–æ“° √æ.√“¡“Π‘∫¥’ °√ÿ߇Σæoe
πæ.Õ”π“® ®‘μ√«√π—πΣå √æ.‡®√‘≠°√ÿߪ√–™“√—°…å °√ÿ߇Σæoe
πæ.Õÿ¥¡ §™‘πΣ√ √æ.»‘√‘√“™ °√ÿ߇Σæoe
πæ.‚ÕÓ√ «‘«—≤π“™à“ß √æ.Õÿ¥√Π“π’ Õÿ¥√Π“π’
29

30. 30
·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“
‚ √ § ° √ ¥ ‰ À ≈ ¬â Õ π „πª√–‡Σ»‰Σ¬
√“¬π“¡ºŸâ‡¢â“ª√–™ÿ¡ —¡¡π“
Consensus for Clinical Practice Guideline „π‡¥Á°
«—πΣ’Ë 14-15 ¡‘∂ÿπ“¬π 2546
≥ ‚√ß·√¡ Anantara ®.‡æ™√∫ÿ√’
æ≠.‡°»√“ Õ—»¥“¡ß§≈ §≥–·æΣ¬»“ μ√å
¡À“«‘Σ¬“≈—¬»√’π§√‘πΣ√«‘‚√≤ π§√𓬰
πæ.≥—∞æß…å Õ—§√º≈ √æ.¡À“√“™π§√‡™’¬ß„À¡à ‡™’¬ß„À¡à
æ≠.π¿Õ√ ¿“«‘®‘μ√ √æ.æ√–¡ß°ÿƇ°≈â“ °√ÿ߇Σæoe
æ≠.𑬖¥“ «‘Σ¬“»—¬ ∂“∫—π ÿ¢¿“懥Á°·Ààß™“μ‘¡À“√“™‘π’ °√ÿ߇Σæoe
æ≠.∫ÿ…∫“ «‘«—≤π凫§‘π √æ.®ÿÓ≈ß°√≥å °√ÿ߇Σæoe
πæ.ª√–æ—πΠå Õà“π‡ª√◊ËÕß √æ.»‘√‘√“™ °√ÿ߇Σæoe
æ≠.ª“𒬓 ‡æ’¬√«‘®‘μ√ √æ.√“¡“Π‘∫¥’ °√ÿ߇Σæoe
æ≠.‡æÁ≠»√’ ‚§« ÿ«√√≥ √æ.»√’π§√‘πΣ√å ¢Õπ·°àπ
æ≠.‡æ’¬ßæ—πΠå ∫ÿ≠»√’ √æ.°√ÿ߇Σæ§√‘ ‡μ’¬π °√ÿ߇Σæoe
æ≠.«√πÿ™ ®ß»√’ «— ¥‘Ï √æ.®ÿÓ≈ß°√≥å °√ÿ߇Σæoe
æ≠.«—π¥’ «√“«‘Σ¬å √æ.√“¡“Π‘∫¥’ °√ÿ߇Σæoe
πæ.«‘°√¡ °√√≥ °ÿ≈ √æ.»‘√‘√“™ °√ÿ߇Σæoe
πæ. ß«π»—°¥‘Ï ƒ°…å»ÿ¿º≈ §≥–·æΣ¬»“ μ√å
¡À“«‘Σ¬“≈—¬»√’π§√‘πΣ√«‘‚√≤ π§√𓬰
æ≠. ÿæ√ μ√’æß…å°√ÿ≥“ √æ.√“¡“Π‘∫¥’ °√ÿ߇Σæoe
¥√. ÿ¿—®©√“ πæ®‘π¥“ √æ.√“¡“Π‘∫¥’ °√ÿ߇Σæoe
πæ.‡ ° ‘μ ‚Õ ∂“°ÿ≈ √æ. ߢ≈“π§√‘πΣ√å ߢ≈“

31. Guideline for the
management of GERD
31
§≥–°√√¡°“√¥”‡π‘πß“π™¡√¡‚¡Π‘≈‘μ’È·Ààߪ√–‡Σ»‰Σ¬
¡“§¡·æΣ¬å√–∫∫Σ“ß‡¥‘πÕ“À“√·Ààߪ√–‡Σ»‰Σ¬
«“√– æ.».2546-2547
1. 𓬷æΣ¬å ‘π Õπÿ√“…Ø√å Σ’Ëª√÷°…“
2. 𓬷æΣ¬åæ‘π‘® °ÿ≈≈–«≥‘™¬å Σ’Ëª√÷°…“
3. ·æΣ¬åÀ≠‘ß«—π¥’ «√“«‘Σ¬å Σ’Ëª√÷°…“
4. 𓬷æΣ¬åÕÿ¥¡ §™‘πΣ√ ª√–Π“π°√√¡°“√
5. æ—π‚Σ𓬷æΣ¬å«“π‘™ ªî¬π‘√—π¥√å ‡À√—≠≠‘°
6. 𓬷æΣ¬å°‘μμ‘ ®—πΣ√å‡≈‘»ƒΣΠ‘Ï °√√¡°“√
7. ·æΣ¬åÀ≠‘ß‚©¡»√’ ‚¶…‘μ™—¬«—≤πå °√√¡°“√
8. 𓬷æΣ¬å«‘ΣŸ√ ™‘π «à“ß«—≤π°ÿ≈ °√√¡°“√
9. 𓬷æΣ¬å∫—≠™“ ‚Õ«“ΣÓ√æ√ °√√¡°“√
10. ·æΣ¬åÀ≠‘ß∫ÿ…∫“ «‘«—≤π凫§‘π °√√¡°“√
11. 𓬷æΣ¬åª√–æ—πΠå Õà“π‡ª√◊ËÕß °√√¡°“√
12. ·æΣ¬åÀ≠‘ß«‚√™“ ¡À“™—¬ °√√¡°“√
13. π“«“‡Õ°π“¬·æΣ¬å«‘≠êŸ ®—πΣ√ ÿπΣ√°ÿ≈ °√√¡°“√
14. 𓬷æΣ¬å»μ«√√… ΣÕß «— ¥‘Ï °√√¡°“√
15. 𓬷æΣ¬å ÿ‡Σæ °≈™“≠«‘Σ¬å °√√¡°“√
16. 𓬷æΣ¬å‡ ° ‘μ ‚Õ ∂“°ÿ≈ °√√√¡°“√
17. æ—π‡Õ°π“¬·æΣ¬å ÿ√æ≈ ÿ√“ߧå»√’√—∞ °√√¡°“√
18. ·æΣ¬åÀ≠‘ß ÿæ√ μ√’æß…å°√ÿ≥“ °√√¡°“√
19. 𓬷æΣ¬å ÿ√‘¬– ®—°°–æ“° °√√¡°“√
20. 𓬷æΣ¬å ¡™“¬ ≈’≈“°ÿ»≈«ß»å °√√¡°“√·≈–‡≈¢“πÿ°“√

32. 32
·π«Σ“ß°“√«‘π‘®©—¬·≈–√—°…“
‚ √ § ° √ ¥ ‰ À ≈ ¬â Õ π „πª√–‡Σ»‰Σ¬
Note......................................................................................................
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