Cho Yu Kyung, Kim Gwang Ha, Kim Jeong Hwan, Jung Hwoon-Yong, Lee Joon Seong, Kim Na Young
Department of Internal Medicine, Seoul Nationsal University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Korean J Gastroenterol. 2010 May;55(5):279-95. doi: 10.4166/kjg.2010.55.5.279.
The prevalence of gastoesophageal reflux disease (GERD) has been rapidly increased in Korea during last 20 years. However, there has been no systematic review regarding this disease. The aim of this article was to provide a review of available diagnostic modalities for GERD. This review includes proton pump inhibitor (PPI) test, endoscopy, ambulatory pH monitoring, impedance pH monitoring, and esophageal manometry in order to provide a basis for the currently applicable recommendations in the diagnosis of GERD in Korea. With weekly heartburn or acid regurgitation, the prevalence of GERD has been reported as 3.4% to 7.9%, indicating an increase of GERD in Korea. As the prevalence of Barrett's esophagus has been reported to be low, the screening endoscopy for Barrett's esophagus is not recommended. Several recent meta-analyses re-evaluated the value of the PPI test in patients with typical GERD symptoms and non-cardiac chest pain. That is, the PPI test has been proven to be a sensitive tool for diagnosing GERD in patients with non-cardiac chest pain and in some preliminary trials regarding extraesophageal manifestations of GERD. Ambulatory pH monitoring of the esophagus helps to confirm gastroesophageal reflux in patients with persistent symptoms (both typical and atypical) in the absence of esophageal mucosal damage, especially when a trial of acid suppression has failed. Impedance pH test is useful in refractory reflux patients with primary complaints of typical GERD symptoms, but this value has not been proved in patients with non-cardiac chest pain or extraesophageal symptoms. This systematic review is targeted to establish the strategy of GERD diagnosis, which is essential for the current clinical practice.
在过去20年里，韩国胃食管反流病（GERD）的患病率迅速上升。然而，尚未有关于该疾病的系统综述。本文旨在对GERD现有的诊断方法进行综述。本综述涵盖质子泵抑制剂（PPI）试验、内镜检查、动态pH监测、阻抗pH监测和食管测压，以便为韩国目前GERD诊断中适用的建议提供依据。据报道，每周出现烧心或反酸症状的GERD患病率为3.4%至7.9%，这表明韩国GERD患病率有所上升。由于据报道巴雷特食管的患病率较低，不建议对巴雷特食管进行筛查性内镜检查。最近的几项荟萃分析重新评估了PPI试验在典型GERD症状和非心源性胸痛患者中的价值。也就是说，在非心源性胸痛患者以及一些关于GERD食管外表现的初步试验中，PPI试验已被证明是诊断GERD的敏感工具。对食管进行动态pH监测有助于在食管黏膜无损伤的情况下，确诊有持续症状（包括典型和非典型症状）的患者是否存在胃食管反流，尤其是在抑酸试验失败时。阻抗pH试验对以典型GERD症状为主诉的难治性反流患者有用，但在非心源性胸痛或食管外症状患者中，其价值尚未得到证实。本系统综述旨在确立GERD诊断策略，这对当前临床实践至关重要。
