Goosenberg Eric, Vadakekut Elsa S.
Temple University School of Medicine
American College of Osteopathic Obstetricians and Gynecologists
Gastroesophageal reflux disease (GERD) is a condition in which retrograde flow of stomach contents into the esophagus or beyond into other regions, eg, oral cavity, larynx, or the lungs, occurs, primarily resulting in inflammation of the esophageal mucosa. This condition is considered one of the most common diseases encountered by gastroenterologists and primary care clinicians. The American College of Gastroenterology (ACG) defines GERD as chronic symptoms or mucosal damage incurred by the abnormal reflux of gastric contents into the esophagus and beyond. Reflux esophagitis secondary to GERD is typically classified as nonerosive reflux disease (NERD) with symptoms or symptomatic disease with esophageal erosions, termed erosive reflux disease. Although reflux esophagitis is generally more common in men, NERD is more prevalent in women. In Western countries, the prevalence of GERD is approximately 10% to 20%, and severe disease is observed in 6% of the population; in Asian countries, the prevalence is approximately 5%. Esophageal reflux may result in complications, including esophagitis, upper gastrointestinal bleeding, anemia, esophageal stricturing, dysphagia, and Barrett esophagus. While GERD alone has been associated with an increased incidence of laryngeal and esophageal squamous cell carcinoma without a definite causal link , Barrett's esophagus is well-known to increase the risk of distal esophageal adenocarcinoma. GERD may also result in extra-gastrointestinal complications, including dental erosions, laryngitis, cough, asthma, sinusitis, and idiopathic pulmonary fibrosis. The most common symptoms of GERD are heartburn, regurgitation, and noncardiac chest pain. The diagnosis of GERD is primarily based on clinical features and patient response to proton pump inhibitors (PPIs). GERD can be presumptively diagnosed in most patients presenting with typical symptoms of heartburn and regurgitation. Additionally, several risk factors contribute to the development of GERD; recognition of these high-risk patients is critical to the timely initiation of preventative and mitigation strategies. Unless alarm symptoms, eg, dysphagia, odynophagia, anemia, weight loss, and hematemesis or melena are concurrent, most patients can be initiated on empiric therapy with PPIs without diagnostic evaluation. However, long-term pharmacologic treatment is indicated if atypical or alarm symptoms are present. The international Lyon Consensus recommends performing diagnostic confirmation of GERD in symptomatic patients before initiating long-term treatment for GERD. In patients who do not improve after taking PPIs, further diagnostic studies, eg, upper endoscopy and ambulatory wireless distal esophageal pH testing, should be performed to confirm GERD and exclude differential diagnoses.
胃食管反流病（GERD）是一种胃内容物逆行流入食管或进一步进入口腔、喉或肺等其他区域的病症，主要导致食管黏膜炎症。这种病症被认为是胃肠病学家和初级保健临床医生遇到的最常见疾病之一。美国胃肠病学会（ACG）将GERD定义为胃内容物异常反流至食管所引起的慢性症状或黏膜损伤。GERD继发的反流性食管炎通常根据内镜检查有无糜烂分为两类：有症状但无糜烂的，称为非糜烂性疾病；有食管糜烂的症状性疾病，称为糜烂性反流病。尽管反流性食管炎一般在男性中更常见，但非糜烂性疾病在女性中更为普遍。在西方国家，GERD的患病率约为10%至20%，6%的人口患有严重疾病；在亚洲国家，患病率约为5%。导致GERD的风险因素包括年龄超过50岁、体重指数>30、吸烟、焦虑、抑郁以及身体活动减少。调节食管下括约肌压力的药物，包括硝酸盐类、钙通道阻滞剂和抗胆碱能药物，也可能导致GERD的发生。食管反流可能导致多种并发症，包括食管炎、上消化道出血、贫血、消化性溃疡、消化性狭窄、吞咽困难、贲门癌和巴雷特食管。GERD还可能导致胃肠道外并发症，包括牙齿侵蚀、喉炎、咳嗽、哮喘、鼻窦炎和特发性肺纤维化。GERD最常见的症状是烧心和反酸。GERD的诊断主要基于临床特征以及患者对质子泵抑制剂（PPI）的反应。大多数出现典型烧心和反流症状的患者可初步诊断为GERD。除非同时出现吞咽困难、吞咽痛、贫血、体重减轻和呕血等警示症状，大多数患者可开始经验性使用PPI治疗；治疗反应支持GERD的诊断。然而，如果出现非典型或警示症状，或需要长期药物治疗，或患者服用PPI后无改善，则应进行进一步的诊断研究，如胃镜检查和动态反流监测，以确诊GERD并排除鉴别诊断。国际里昂共识建议，在对GERD进行侵入性或长期治疗之前，通过这些诊断研究获取反流性食管炎改变的证据，对有症状的患者进行GERD的诊断确认。出现胸痛的患者在开始胃肠道评估之前应进行检查以排除胸痛的心脏原因。对于轻度至中度GERD症状的患者，管理措施包括生活方式改变、必要时使用PPI治疗并辅以其他药物治疗，以及治疗任何食管反流并发症。对初始治疗策略无反应的严重GERD患者可能需要进行侵入性手术，如腹腔镜胃底折叠术或磁性括约肌增强术。
