Marabotto Elisa, Pasta Andrea, Calabrese Francesco, Ribolsi Mentore, Mari Amir, Savarino Vincenzo, Savarino Edoardo Vincenzo
Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy.
IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Visc Med. 2024 Oct;40(5):242-249. doi: 10.1159/000536583. Epub 2024 Mar 13.
This review addresses the intricate spectrum of gastroesophageal reflux disease (GERD), a condition affecting 10-30% of the Western population. GERD is characterized by the backflow of gastric contents into the esophagus, causing typical and atypical symptoms. Its pathophysiology involves various factors such as hiatal hernia, esophageal motor disorders, and dietary triggers. The review explores the complexities of GERD spectrum, including nonerosive reflux disease (NERD), reflux hypersensitivity (RH), and functional heartburn (FH).
The diagnostic process for GERD, based on the Lyon Consensus 2.0 criteria, encompasses clinical evaluation, endoscopy, and functional tests, including pH-impedance and wireless-pH monitoring. NERD, a significant subset of GERD, is defined by reflux symptoms and abnormal reflux burden without mucosal damage. RH, classified under functional esophageal disorders by Rome IV criteria, presents with typical esophageal symptoms associated with reflux but lacks of structural, inflammatory, or motor causes. FH is identified by heartburn with normal endoscopy, reflux testing, and esophageal manometry results. The management of RH and FH, focusing on reducing esophageal hypersensitivity, varies from standard GERD treatments.
The review emphasizes the necessity of personalized treatment strategies due to the complexity and overlap of GERD subtypes. It highlights the importance of a multidisciplinary approach, involving gastroenterologists, psychologists, and other specialists, to improve patient outcomes and quality of life. The article underscores that understanding the distinctions and overlaps among NERD, RH, and FH is crucial for effective management, and the need for innovative approaches in diagnosis and treatment to address the unique challenges of each subtype.
本综述探讨了胃食管反流病（GERD）的复杂范围，该病影响着10%至30%的西方人群。GERD的特征是胃内容物反流至食管，导致典型和非典型症状。其病理生理学涉及多种因素，如食管裂孔疝、食管运动障碍和饮食诱因。本综述探讨了GERD范围的复杂性，包括非糜烂性反流病（NERD）、反流高敏反应（RH）和功能性烧心（FH）。
基于里昂共识2.0标准的GERD诊断过程包括临床评估、内镜检查和功能测试，包括pH阻抗监测和无线pH监测。NERD是GERD的一个重要子集，由反流症状和异常反流负荷定义，但无黏膜损伤。根据罗马IV标准，RH归类为功能性食管疾病，表现为与反流相关的典型食管症状，但缺乏结构性、炎症性或运动性病因。FH通过内镜检查、反流测试和食管测压结果正常的烧心来确定。RH和FH的管理重点是降低食管超敏反应，与标准GERD治疗不同。
本综述强调由于GERD亚型的复杂性和重叠性，个性化治疗策略的必要性。它强调了多学科方法的重要性，涉及胃肠病学家、心理学家和其他专家，以改善患者预后和生活质量。文章强调，了解NERD、RH和FH之间的区别和重叠对于有效管理至关重要，并且需要创新的诊断和治疗方法来应对每种亚型的独特挑战。
