当前位置: X-MOL 学术Clin. Gastroenterol. Hepatol. › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Phenotypes of Gastroesophageal Reflux Disease: Where Rome, Lyon, and Montreal Meet.
Clinical Gastroenterology and Hepatology ( IF 12.6 ) Pub Date : 2019-07-15 , DOI: 10.1016/j.cgh.2019.07.015
David A Katzka 1 , John E Pandolfino 2 , Peter J Kahrilas 2
Affiliation  

Gastroesophageal reflux disease (GERD) is now one of the most common diagnoses made in a gastroenterology practice. From a conventional pathophysiological perspective, GERD is conceptualized as incompetence of the antireflux barrier at the esophagogastric junction; the more severe that incompetence, the worse the disease. However, it is increasingly clear that many presentations of GERD represent distinct phenotypes with unique predisposing cofactors and pathophysiology outside of this paradigm. Three major consensus initiatives have grappled with this dilemma (the Montreal Consensus, The Rome Foundation, and the Lyon Consensus), each from a different perspective. Montreal struggled to define the disease, Rome sought to characterize its functional attributes, while Lyon examined its physiological attributes. Here, we merge the 3 perspectives, developing the concept that what has come to be known as GERD is actually a family of syndromes with a complex matrix of contributing pathophysiology. A corollary to this is that the concept of one size fits all to therapeutics does not apply, and that although escalating treatment with proton pump inhibitors (PPIs) may be pertinent to healing esophagitis, its applicability beyond that is highly questionable. Similarly, failing to recognize the modulating effects of anxiety, hypervigilance, and visceral and central hypersensitivity on symptom severity has greatly oversimplified the problem. That oversimplification has led to excessive use of PPIs for everything captured under the GERD umbrella and shown a broad spectrum of syndromes less amenable to PPI therapy in any dose. It is with this in mind that we delineate this precision medicine concept of GERD.

中文翻译:

胃食管反流病的表型:罗马、里昂和蒙特利尔的交汇处。

胃食管反流病 (GERD) 现在是胃肠病学实践中最常见的诊断之一。从传统的病理生理学角度来看,GERD 被概念化为食管胃交界处抗反流屏障功能不全;无能越严重,疾病就越严重。然而,越来越清楚的是,GERD 的许多表现代表了不同的表型,具有独特的易感辅助因素和该范式之外的病理生理学。三项主要的共识倡议(蒙特利尔共识、罗马基金会和里昂共识)都从不同的角度解决了这一困境。蒙特利尔努力定义这种疾病,罗马试图描述其功能特征,而里昂则研究其生理特征。在这里,我们合并了 3 个视角,发展出一个概念,即后来被称为 GERD 的实际上是一组综合征,具有复杂的病理生理学矩阵。对此的一个推论是,一刀切的概念不适用于治疗,并且虽然使用质子泵抑制剂 (PPI) 升级治疗可能与治愈食管炎有关,但其适用性非常值得怀疑。同样,未能认识到焦虑、过度警觉以及内脏和中枢过敏对症状严重程度的调节作用,大大简化了问题。这种过度简化导致过度使用 PPI 用于 GERD 保护伞下捕获的所有内容,并显示出广泛的综合征,在任何剂量下都不太适合 PPI 治疗。
更新日期:2020-03-19
down
wechat
bug