Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, 94305, USA.
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway Street 3rd floor, MC6341, Redwood City, CA, 94063, USA.
Dig Dis Sci. 2023 Sep;68(9):3542-3554. doi: 10.1007/s10620-023-08008-x. Epub 2023 Jul 20.
We define mixed esophageal disease (MED) as a disorder of esophageal structure and/or function that produces variable signs or symptoms, simulating-fully or in part other well-defined esophageal conditions, such as gastroesophageal reflux disease, esophageal motility disorders, or even neoplasia. The central premise of the MED concept is that of an overlap syndrome that incorporates selected clinical, endoscopic, imaging, and functional features that alter the patient's quality of life and affect natural history, prognosis, and management. In this article, we highlight MED scenarios frequently encountered in medico-surgical practices worldwide, posing new diagnostic and therapeutic challenges. These, in turn, emphasize the need for better understanding and management, aiming towards improved outcomes and prognosis. Since MED has variable and sometimes time-evolving clinical phenotypes, it deserves proper recognition, definition, and collaborative, multidisciplinary approach, be it pharmacologic, endoscopic, or surgical, to optimize therapeutic outcomes, while minimizing iatrogenic complications. In this regard, it is best to define MED early in the process, preferably by teams of clinicians with expertise in managing esophageal diseases. MED is complex enough that is increasingly becoming the subject of virtual, multi-disciplinary, multi-institutional meetings.
我们将混合性食管疾病（MED）定义为一种食管结构和/或功能障碍的疾病，其产生的症状或体征可变，模拟了其他明确的食管疾病，如胃食管反流病、食管动力障碍，甚至肿瘤的全部或部分特征。MED 概念的核心前提是重叠综合征，它包含了选定的临床、内镜、影像学和功能特征，这些特征改变了患者的生活质量，并影响其自然病史、预后和管理。在本文中，我们强调了全球医学和外科实践中经常遇到的 MED 情况，这些情况带来了新的诊断和治疗挑战。反过来，这强调了需要更好地理解和管理，旨在改善结果和预后。由于 MED 具有可变的且有时是随时间演变的临床表型，因此需要对其进行适当的识别、定义和协作性多学科方法，无论是药物治疗、内镜治疗还是手术治疗，以优化治疗效果，同时最大限度地减少医源性并发症。在这方面，最好在早期就对 MED 进行定义，最好由具有食管疾病管理专业知识的临床医生团队来进行。MED 非常复杂，以至于它越来越成为虚拟、多学科、多机构会议的主题。
