Snyder Diana L, Katzka David A
Gastroenterology, Mayo Clinic, Rochester, Minnesota.
Gastroenterology, Columbia University, New York, New York.
Gastro Hep Adv. 2022 Apr 5;1(3):420-430. doi: 10.1016/j.gastha.2022.02.014. eCollection 2022.
Gastroesophageal reflux disease (GERD) is the most prevalent gastrointestinal disorder posing diagnostic and therapeutic challenges. Diagnosis should be objectively defined with endoscopy and pH testing, while novel metrics may augment diagnosis for inconclusive GERD cases, including the postreflux swallow-induced peristaltic wave index and esophageal mucosal impedance. Conditions that overlap with or mimic GERD should be considered such as achalasia, rumination, and eosinophilic esophagitis. Genetic testing for proton pump inhibitor metabolism is an option for precision therapy in complex persistent GERD. Proton pump inhibitor refractory GERD may require medical, surgical, or endoscopic therapies. The presence of GERD should be objectively evaluated in achalasia patients treated with peroral endoscopic myotomy, and further studies are needed to determine timing of this evaluation. Patients with scleroderma are at a high risk for GERD owing to abnormal esophageal motility and should be managed with aggressive medical therapy and lifestyle changes given the high prevalence of esophagitis and Barrett's esophagus in this population. Further studies are needed to understand the complex mechanisms of GERD in idiopathic pulmonary fibrosis and lung transplantation.
胃食管反流病（GERD）是最常见的胃肠道疾病，带来诊断和治疗方面的挑战。诊断应通过内镜检查和pH测试客观确定，而新的指标可能有助于对不确定的GERD病例进行诊断，包括反流后吞咽诱发蠕动波指数和食管黏膜阻抗。应考虑与GERD重叠或相似的情况，如贲门失弛缓症、反刍综合征和嗜酸性食管炎。质子泵抑制剂代谢的基因检测是复杂持续性GERD精准治疗的一种选择。质子泵抑制剂难治性GERD可能需要药物、手术或内镜治疗。在接受经口内镜下肌切开术治疗的贲门失弛缓症患者中，应客观评估GERD的存在，还需要进一步研究以确定该评估的时机。硬皮病患者由于食管动力异常，发生GERD的风险很高，鉴于该人群食管炎和巴雷特食管的高患病率，应积极进行药物治疗和改变生活方式。需要进一步研究以了解特发性肺纤维化和肺移植中GERD的复杂机制。
