Sherman Philip M, Hassall Eric, Fagundes-Neto Ulysses, Gold Benjamin D, Kato Seiichi, Koletzko Sibylle, Orenstein Susan, Rudolph Colin, Vakil Nimish, Vandenplas Yvan
Gastroenterology-Pediatric, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Am J Gastroenterol. 2009 May;104(5):1278-95; quiz 1296. doi: 10.1038/ajg.2009.129. Epub 2009 Apr 7.
To develop an international consensus on the definition of gastroesophageal reflux disease (GERD) in the pediatric population.
Using the Delphi process, a set of statements was developed and voted on by an international panel of eight pediatric gastroenterologists. Statements were based on systematic literature searches using Medline, EMBASE, and CINAHL. Voting was conducted using a six-point scale, with consensus defined, a priori, as agreed by 75% of the group. The strength of each statement was assessed using the GRADE system.
There were four rounds of voting. In the final vote, consensus was reached on 98% of the 59 statements. In this vote, 95% of the statements were accepted by seven of eight voters. Consensus items of particular note were: (i) GERD is present when reflux of gastric contents causes troublesome symptoms and/or complications, but this definition is complicated by unreliable reporting of symptoms in children under the age of approximately 8 years; (ii) histology has limited use in establishing or excluding a diagnosis of GERD; its primary role is to exclude other conditions; (iii) Barrett's esophagus should be defined as esophageal metaplasia that is intestinal metaplasia positive or negative; and (iv) extraesophageal conditions may be associated with GERD, but for most of these conditions causality remains to be established.
The consensus statements that comprise the Definition of GERD in the Pediatric Population were developed through a rigorous process. These statements are intended to be used for the development of future clinical practice guidelines and as a basis for clinical trials.
就小儿胃食管反流病（GERD）的定义达成国际共识。
采用德尔菲法，由八名儿科胃肠病学家组成的国际小组制定并投票表决了一组声明。声明基于使用Medline、EMBASE和CINAHL进行的系统文献检索。投票采用六点量表进行，事先将75%的小组成员达成一致定义为共识。使用GRADE系统评估每条声明的强度。
进行了四轮投票。在最后一轮投票中，59条声明中有98%达成了共识。在这次投票中，8名投票者中有7名接受了95%的声明。特别值得注意的共识项目包括：（i）当胃内容物反流引起令人烦恼的症状和/或并发症时，即存在GERD，但对于大约8岁以下儿童，症状报告不可靠使这一定义变得复杂；（ii）组织学在确立或排除GERD诊断方面用途有限；其主要作用是排除其他疾病；（iii）巴雷特食管应定义为肠化生阳性或阴性的食管化生；（iv）食管外疾病可能与GERD有关，但对于大多数这些疾病，因果关系仍有待确定。
《小儿胃食管反流病定义》中的共识声明是通过严格的过程制定的。这些声明旨在用于制定未来的临床实践指南，并作为临床试验的基础。
