Pace F, Manes G, Conio M, Bianchi Porro G
Dept. of Gastroenterology, L. Sacco University Hospital, Via G.B.Grassi 74, 20157 Milan, Italy.
Endoscopy. 2006 Mar;38(3):271-5. doi: 10.1055/s-2006-924971.
Most current endoscopic guidelines do not recommend the use of routine esophagoscopy in the evaluation of patients with typical symptoms of gastroesophageal reflux disease (GERD), unless alarm features are present. In patients with known reflux esophagitis, esophagoscopy is considered to have no role either in the further management or follow-up. Screening of reflux patients for Barrett's esophagus is not considered to be cost-effective. On the basis of a critical review of the available literature, and of some recent papers in particular, we disagree with these suggestions. We would argue, on the contrary, that a negative esophagoscopy can provide the GERD patient with reassurance, and that esophagoscopy allows targeted therapy to be offered if it is positive for esophagitis. When Barrett's esophagus is diagnosed, it usually leads to a surveillance program being initiated. The potential benefits of endoscopy for the patient's quality of life are probably underestimated when financial issues alone are taken into account. Even if it is true that a large percentage of GERD patients do not have endoscopic abnormalities (those with nonerosive reflux disease), surrogate tests such as the proton-pump inhibitor test or symptom questionnaires do not provide a more accurate diagnosis. We would therefore suggest that, at least in the specialist setting, all patients with suspected GERD should undergo accurate symptom analysis as well as endoscopic evaluation before treatment is started.
目前大多数内镜指南不建议在评估有典型胃食管反流病（GERD）症状的患者时常规使用食管镜检查，除非存在警示特征。对于已知有反流性食管炎的患者，食管镜检查在进一步治疗或随访中被认为没有作用。对反流患者进行巴雷特食管筛查不被认为具有成本效益。基于对现有文献的批判性回顾，特别是一些近期的论文，我们不同意这些建议。相反，我们认为食管镜检查结果为阴性可以让GERD患者放心，如果食管镜检查显示食管炎阳性，则可以进行有针对性的治疗。当诊断出巴雷特食管时，通常会启动监测程序。仅考虑经济问题时，内镜检查对患者生活质量的潜在益处可能被低估了。即使确实有很大比例的GERD患者没有内镜异常（即非糜烂性反流病患者），诸如质子泵抑制剂试验或症状问卷等替代检查也不能提供更准确的诊断。因此，我们建议，至少在专科环境中，所有疑似GERD的患者在开始治疗前都应进行准确的症状分析以及内镜评估。
