Diagnosis and differential diagnosis of gastroesophageal reflux disease: detection methods and evaluation
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摘要: 胃食管反流病(gastroesophageal reflux disease，GERD)是常见的消化系统疾病之一。GERD的发病与酸反流、炎症、动力、内脏高敏感等多种因素相关，其临床表现复杂多样，抑酸治疗的反应不一，因此，GERD的诊断与鉴别诊断是消化科医生面临的一大难题。GERD的诊断方法包括症状评估、抑酸剂诊断性试验、上消化道内镜、食管反流监测、黏膜阻抗、高分辨率食管测压、食管钡剂造影、内镜下功能性腔道成像探针及唾液胃蛋白酶检测等。不同诊断方法各有优劣，其诊断和鉴别诊断有赖于不同诊断技术的综合评估。2024年发表的里昂共识2.0对GERD的诊断标准，包括确定性、不确定性和排除性证据进行了更新，为GERD的诊断提供了更全面的指导。Abstract: Gastroesophageal reflux disease(GERD) is one of the common digestive system diseases. The onset of GERD is related to multiple factors such as acid reflux, inflammation, motility, and visceral hypersensitivity. Its clinical manifestations are complex and diverse, and the response to acid-suppressing treatment varies. Therefore, the diagnosis and differential diagnosis of GERD is one of the challenges for gastroenterologists. Diagnostic methods of GERD include symptom assessment, diagnostic tests with acid-suppressing agents, upper gastrointestinal endoscopy, esophageal reflux monitoring, mucosal impedance, high-resolution esophageal manometry, esophageal barium radiography, endoscopic functional lumen imaging probes, and salivary pepsin detection, etc. Each diagnostic method has its advantages and disadvantages. The diagnosis and differential diagnosis of GERD relies on the comprehensive evaluation of different diagnostic techniques. Lyon Consensus 2.0, published in 2024, has updated the diagnostic criteria and algorithm for GERD, including conclusive, borderline, and exclusionary evidence, thus providing more comprehensive guidance for the modern diagnosis of GERD.
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