Institute of Pathology, Klinikum Bayreuth, Preuschwitzerstr. 101, 95445 Bayreuth, Germany.
Best Pract Res Clin Gastroenterol. 2013 Jun;27(3):373-85. doi: 10.1016/j.bpg.2013.06.010.
Gastroesophageal reflux disease (GERD) is a diagnosis applicable to "all individuals who are exposed to the risk of physical complications from gastroesophageal reflux, or who experience clinically significant impairment of health related well being (quality of life) due to reflux related symptoms, after adequate reassurance of the benign nature of their symptoms". It remains, predominantly, a symptom-based diagnosis, confirmed clinically by a response to acid suppression therapy although it is accompanied by demonstrable increases in acid exposure on esophageal pH-metry and by endoscopic and histological changes. Standard white light endoscopy permits diagnosis of erosive reflux disease (ERD) which, if present, should be graded for severity using the Los Angeles classification system. However, the role of endoscopy in clinical practice is, primarily, to evaluate patients with persistent symptoms, despite medical therapy, or to investigate alarm features and exclude complications such as Barrett' oesophagus which should be assessed using the Prague C & M criteria. Newer endoscopic techniques allow detection of 'minimal change' GERD lesions and Barrett's oesophagus-associated dysplastic or neoplastic lesions; however, none of the newer techniques has been validated for routine clinical practice. There is an increasing recognition that histology in GERD may provide useful diagnostic information, in part to exclude other lesions, such as eosinophilic oesophagitis, intestinal metaplasia and dysplasia or malignancy and, in part, to identify changes, such as basal cell hyperplasia, papillary elongation and, most recently, dilated intercellular spaces, that are consistent with GERD. However, more widespread incorporation of histology into the clinical management of GERD will require a standardized biopsy protocol and efforts to minimise interobserver differences in the identification of GERD-related histological changes.
胃食管反流病（GERD）是一种适用于“所有因胃酸反流而面临生理并发症风险，或因反流相关症状导致健康相关生活质量（生活质量）显著受损的个体”的诊断。它主要是一种基于症状的诊断，通过酸抑制治疗的反应在临床上得到确认，尽管它伴随着食管 pH 监测中酸暴露的增加以及内镜和组织学变化。标准白光内镜可诊断糜烂性反流病（ERD），如果存在，则应根据洛杉矶分类系统对其严重程度进行分级。然而，内镜在临床实践中的主要作用是评估尽管接受了药物治疗但仍持续存在症状的患者，或评估报警特征并排除并发症，如巴雷特食管，应使用布拉格 C&M 标准进行评估。较新的内镜技术可检测到“微小变化”GERD 病变和 Barrett 食管相关的异型增生或肿瘤性病变；然而，尚无一种新技术已验证可用于常规临床实践。人们越来越认识到，GERD 中的组织学可能提供有用的诊断信息，部分是为了排除其他病变，如嗜酸性食管炎、肠化生和异型增生或恶性肿瘤，部分是为了识别与 GERD 一致的变化，如基底细胞增生、乳头伸长和最近发现的细胞间隙扩张。然而，要将组织学更广泛地纳入 GERD 的临床管理中，需要标准化的活检方案，并努力减少观察者间在识别 GERD 相关组织学变化方面的差异。
