In most patients presenting without alarm features, gastro-oesophageal reflux disease (GORD) is diagnosed empirically, based on symptoms assessment and response to medical therapy, mainly proton pump inhibitors (PPIs). Despite its low specificity (placebo response) and the risk of PPI overuse, the empiric PPI trial is cost-effective and recommended as a first line strategy when GORD is suspected.1 Additional testing is indicated when empiric treatment fails to provide adequate symptom relief and/or prior antireflux surgery. In 2017, the so-called ‘Lyon consensus’ experts proposed guidelines for GORD diagnosis based on the results of endoscopy and ambulatory pH (impedance) monitoring. Briefly, these experts considered as a conclusive diagnosis of GORD the presence of Los Angeles grade C/D oesophagitis, peptic stricture, long-segment Barrett’s mucosa or acid exposure time (AET) superior to 6% on pH monitoring. An AET below 4% is considered as definitely normal, and consequently, the experts acknowledged the possibility of an inconclusive diagnosis in patients with an AET between 4% and 6%: the ‘grey area’. In this situation, considering additional parameters (baseline impedance, histology, oesophageal motility abnormalities) may help to shrink this area as much as possible. In Gut , Rusu et al report the results of a study …

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GORD 诊断：“灰色地带”是否在扩大？

在大多数没有警报特征的患者中，胃食管反流病 (GORD) 是根据症状评估和对药物治疗的反应（主要是质子泵抑制剂 (PPI)）凭经验诊断的。尽管其特异性低（安慰剂反应）和 PPI 过度使用的风险，经验性 PPI 试验具有成本效益，并推荐作为怀疑 GORD 时的一线策略。1 当经验性治疗未能提供足够的症状缓解和/ 或之前的抗反流手术。2017年，所谓的“里昂共识”专家根据内窥镜检查和动态pH（阻抗）监测结果提出了GORD诊断指南。简而言之，这些专家认为存在洛杉矶 C/D 级食管炎、消化性狭窄、长段 Barrett 粘膜或酸暴露时间 (AET) 在 pH 监测中优于 6%。AET 低于 4% 被认为是绝对正常的，因此，专家们承认 AET 介于 4% 和 6% 之间的患者有可能做出不确定的诊断：“灰色区域”。在这种情况下，考虑其他参数（基线阻抗、组织学、食管运动异常）可能有助于尽可能缩小该区域。在 Gut 中，Rusu 等人报告了一项研究结果…… 食道运动异常）可能有助于尽可能缩小该区域。在 Gut 中，Rusu 等人报告了一项研究结果…… 食道运动异常）可能有助于尽可能缩小该区域。在 Gut 中，Rusu 等人报告了一项研究结果……