Naik Rishi D, Vaezi Michael F
a Division of Gastroenterology, Hepatology, and Nutrition, Center for Swallowing and Esophageal Disorders , Vanderbilt University Medical Center , Nashville , TN , USA.
Expert Rev Gastroenterol Hepatol. 2017 Jun;11(6):531-537. doi: 10.1080/17474124.2017.1309286. Epub 2017 Mar 27.
Gastroesophageal reflux disease (GERD) has a large economic burden with important complications that include esophagitis, Barrett's esophagus, and adenocarcinoma. Despite endoscopy, validated patient questionnaires, and traditional ambulatory pH monitoring, the diagnosis of GERD continues to be challenging. Areas covered: This review will explore the difficulties in diagnosing GERD with a focus on new developments, ranging from basic fundamental changes (histology and immunohistochemistry) to direct patient care (narrow-band imaging, impedance, and response to anti-reflux surgery). We searched PubMed using the noted keywords. We included data from full-text articles published in English. Further relevant articles were identified from the reference lists of review articles. Expert commentary: Important advances in novel parameters in intraluminal impedance monitoring such as baseline impedance monitoring has created some insight into alternative diagnostic strategies in GERD. Recent advances in endoscopic assessment of esophageal epithelial integrity via mucosal impedance measurement is questioning the paradigm of prolonged ambulatory testing for GERD. The future of reflux diagnosis may very well be without the need for currently employed technologies and could be as simple as assessing changes in epithelia integrity as a surrogate marker for GERD. However, future studies must validate such an approach.
胃食管反流病（GERD）具有巨大的经济负担，并伴有包括食管炎、巴雷特食管和腺癌在内的重要并发症。尽管有内镜检查、经过验证的患者问卷以及传统的动态pH监测，但GERD的诊断仍然具有挑战性。涵盖领域：本综述将探讨GERD诊断中的困难，重点关注新进展，从基本的根本性变化（组织学和免疫组织化学）到直接的患者护理（窄带成像、阻抗以及抗反流手术的反应）。我们使用指定的关键词在PubMed上进行了搜索。我们纳入了以英文发表的全文文章中的数据。从综述文章的参考文献列表中确定了更多相关文章。专家评论：腔内阻抗监测中的新参数，如基线阻抗监测，取得的重要进展为GERD的替代诊断策略提供了一些见解。通过黏膜阻抗测量对食管上皮完整性进行内镜评估的最新进展，正在质疑GERD长期动态检测的模式。反流诊断的未来很可能无需目前使用的技术，可能简单到只需评估上皮完整性的变化作为GERD的替代标志物。然而，未来的研究必须验证这种方法。
