PDF(Pubmed)
Abstract：
Gastroesophageal reflux disease (GERD) is the most prevalent gastrointestinal disorder posing diagnostic and therapeutic challenges. Diagnosis should be objectively defined with endoscopy and pH testing, while novel metrics may augment diagnosis for inconclusive GERD cases, including the postreflux swallow-induced peristaltic wave index and esophageal mucosal impedance. Conditions that overlap with or mimic GERD should be considered such as achalasia, rumination, and eosinophilic esophagitis. Genetic testing for proton pump inhibitor metabolism is an option for precision therapy in complex persistent GERD. Proton pump inhibitor refractory GERD may require medical, surgical, or endoscopic therapies. The presence of GERD should be objectively evaluated in achalasia patients treated with peroral endoscopic myotomy, and further studies are needed to determine timing of this evaluation. Patients with scleroderma are at a high risk for GERD owing to abnormal esophageal motility and should be managed with aggressive medical therapy and lifestyle changes given the high prevalence of esophagitis and Barrett\'s esophagus in this population. Further studies are needed to understand the complex mechanisms of GERD in idiopathic pulmonary fibrosis and lung transplantation.
摘要：
胃食管反流病（GERD）是最常见的胃肠道疾病，对诊断和治疗提出了挑战。诊断应通过内窥镜检查和pH检测客观确定。虽然新的指标可能会增强对不确定的GERD病例的诊断，包括吞咽后引起的蠕动波指数和食管粘膜阻抗。应考虑与GERD重叠或模拟GERD的情况，如贲门失弛缓症，沉思，和嗜酸性粒细胞性食管炎.质子泵抑制剂代谢的基因检测是复杂持续性GERD精准治疗的一种选择。质子泵抑制剂难治性GERD可能需要医疗，外科,或内窥镜治疗。应客观评估经口内镜肌切开术治疗的门失弛缓症患者是否存在GERD，需要进一步的研究来确定评估的时机。硬皮病患者由于食管运动异常而有很高的GERD风险，鉴于该人群中食管炎和Barrett食管的患病率较高，应采取积极的药物治疗和生活方式改变。需要进一步的研究来了解GERD在特发性肺纤维化和肺移植中的复杂机制。
