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Modern diagnosis of GERD: the Lyon Consensus
Gut ( IF 24.5 ) Pub Date : 2018-02-03 , DOI: 10.1136/gutjnl-2017-314722
C Prakash Gyawali , Peter J Kahrilas , Edoardo Savarino , Frank Zerbib , Francois Mion , André J P M Smout , Michael Vaezi , Daniel Sifrim , Mark R Fox , Marcelo F Vela , Radu Tutuian , Jan Tack , Albert J Bredenoord , John Pandolfino , Sabine Roman

Clinical history, questionnaire data and response to antisecretory therapy are insufficient to make a conclusive diagnosis of GERD in isolation, but are of value in determining need for further investigation. Conclusive evidence for reflux on oesophageal testing include advanced grade erosive oesophagitis (LA grades C and D), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal oesophageal acid exposure time (AET) >6% on ambulatory pH or pH-impedance monitoring. A normal endoscopy does not exclude GERD, but provides supportive evidence refuting GERD in conjunction with distal AET <4% and <40 reflux episodes on pH-impedance monitoring off proton pump inhibitors. Reflux-symptom association on ambulatory reflux monitoring provides supportive evidence for reflux triggered symptoms, and may predict a better treatment outcome when present. When endoscopy and pH or pH-impedance monitoring are inconclusive, adjunctive evidence from biopsy findings (histopathology scores, dilated intercellular spaces), motor evaluation (hypotensive lower oesophageal sphincter, hiatus hernia and oesophageal body hypomotility on high-resolution manometry) and novel impedance metrics (baseline impedance, postreflux swallow-induced peristaltic wave index) can add confidence for a GERD diagnosis; however, diagnosis cannot be based on these findings alone. An assessment of anatomy, motor function, reflux burden and symptomatic phenotype will therefore help direct management. Future GERD management strategies should focus on defining individual patient phenotypes based on the level of refluxate exposure, mechanism of reflux, efficacy of clearance, underlying anatomy of the oesophagogastric junction and psychometrics defining symptomatic presentations.

中文翻译:

GERD的现代诊断:里昂共识

临床病史、问卷调查数据和对抗分泌治疗的反应不足以单独做出 GERD 的结论性诊断,但对于确定进一步调查的必要性具有价值。食管检测反流的确凿证据包括晚期糜烂性食管炎(LA C 级和 D 级)、长段 Barrett 粘膜或内窥镜下的消化性狭窄,或动态 pH 或 pH 阻抗监测中远端食管酸暴露时间 (AET) >6% . 正常的内窥镜检查不能排除 GERD,但提供了支持性证据,反驳了 GERD 与远端 AET <4% 和 <40 次反流发作有关的质子泵抑制剂的 pH 阻抗监测。动态反流监测中的反流症状关联为反流引发的症状提供了支持性证据,并且可能会在出现时预测更好的治疗结果。当内窥镜检查和 pH 或 pH 阻抗监测不确定时,活检结果(组织病理学评分、扩张的细胞间隙)、运动评估(低食管下括约肌、裂孔疝和食管体运动低下高分辨率测压)和新的阻抗指标的辅助证据(基线阻抗、反流后吞咽诱导的蠕动波指数)可以增加对 GERD 诊断的信心;然而,诊断不能仅基于这些发现。因此,对解剖结构、运动功能、反流负担和症状表型的评估将有助于直接管理。未来的 GERD 管理策略应侧重于根据反流暴露水平、反流机制、清除效果、
更新日期:2018-02-03
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