Desai Madhav, Ruan Wenly, Thosani Nirav C, Amaris Manuel, Scott J Stephen, Saeed Ahmed, Abu Dayyeh Barham, Canto Marcia Irene, Abidi Wasif, Alipour Omeed, Amateau Stuart K, Cosgrove Natalie, Elhanafi Sherif E, Forbes Nauzer, Kohli Divyanshoo R, Kwon Richard S, Fujii-Lau Larissa L, Machicado Jorge D, Marya Neil B, Ngamruengphong Saowanee, Pawa Swati, Sheth Sunil G, Thiruvengadam Nikhil R, Qumseya Bashar J
Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA.
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
Gastrointest Endosc. 2025 Feb;101(2):267-284. doi: 10.1016/j.gie.2024.10.008. Epub 2024 Dec 17.
This clinical practice guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides an evidence-based approach for strategies to diagnose and manage GERD. This document was developed using the Grading of Recommendations Assessment, Development, and Evaluation framework and serves as an update to the 2014 ASGE guideline on the role of endoscopy in the management of GERD. This updated guideline addresses the indications for endoscopy in patients with GERD as well as in the emerging population of patients who develop GERD after sleeve gastrectomy or peroral endoscopic myotomy. It also discusses how to endoscopically evaluate gastroesophageal junctional integrity in a comprehensive and uniform manner. Importantly, this guideline also discusses management strategies for GERD including the role of lifestyle interventions, proton pump inhibitors (PPIs), and endoscopic antireflux therapy (including transoral incisionless fundoplication [TIF], radiofrequency energy, and combined hiatal hernia repair and TIF [cTIF]) in the management of GERD. The ASGE suggests upper endoscopy for the evaluation of GERD in patients with alarm symptoms, with multiple risk factors for Barrett's esophagus, and with a history of sleeve gastrectomy. The ASGE recommends careful endoscopic evaluation, reporting, and photo-documentation of objective GERD findings with attention to gastroesophageal junction landmarks and integrity in patients who undergo upper endoscopy to improve care. In patients with GERD symptoms, the ASGE recommends lifestyle modifications. In patients with symptomatic and confirmed GERD with predominant heartburn symptoms, the ASGE recommends medical management including PPIs at the lowest dose for the shortest duration possible while initiating discussion about long-term management options. In patients with confirmed GERD with small hiatal hernias (≤2 cm) and Hill grade I or II who meet specific criteria, the ASGE suggests evaluation for TIF as an alternative to chronic medical management. In patients with persistent GERD with large hiatal hernias (> 2cm) and Hill grade III or IV, the ASGE suggests either cTIF or surgical therapy based on multidisciplinary review. This document summarizes the methods, analyses, and decision processes used to reach the final recommendations and represents the official ASGE recommendations on the above topics.
美国胃肠内镜学会（ASGE）的这份临床实践指南为胃食管反流病（GERD）的诊断和管理策略提供了循证方法。本文件采用推荐分级评估、制定和评价框架制定，是2014年ASGE关于内镜检查在GERD管理中作用的指南的更新版本。这份更新后的指南阐述了GERD患者以及在袖状胃切除术后或经口内镜下肌切开术后出现GERD的新患病人群的内镜检查适应证。它还讨论了如何以全面且统一的方式在内镜下评估胃食管交界处的完整性。重要的是，本指南还讨论了GERD的管理策略，包括生活方式干预、质子泵抑制剂（PPI）以及内镜抗反流治疗（包括经口无切口胃底折叠术 [TIF]、射频能量以及联合食管裂孔疝修补术和TIF [cTIF]）在GERD管理中的作用。ASGE建议对有警示症状、有巴雷特食管多种危险因素以及有袖状胃切除术病史的GERD患者进行上消化道内镜检查。ASGE建议对上消化道内镜检查的患者进行仔细的内镜评估、报告以及客观GERD发现的照片记录，同时关注胃食管交界处的标志和完整性，以改善治疗。对于有GERD症状的患者，ASGE建议进行生活方式调整。对于有症状且确诊为以烧心症状为主的GERD患者，ASGE建议进行药物治疗，包括使用最低剂量的PPI并尽可能缩短疗程，同时开始讨论长期管理方案。对于确诊为GERD且食管裂孔疝较小（≤2 cm）且希尔分级为I级或II级且符合特定标准的患者，ASGE建议评估TIF作为慢性药物治疗的替代方案。对于有大食管裂孔疝（> 2cm）且希尔分级为III级或IV级的持续性GERD患者，ASGE建议根据多学科评估结果选择cTIF或手术治疗。本文件总结了用于得出最终推荐意见的方法、分析和决策过程，代表了ASGE对上述主题的官方推荐。
