以食管外症状为主要表现的胃食管反流病诊断方法的研究进展

doi:10.3877/cma.j.issn.2095-8765.2021.01.006

胃食管反流病（GERD）是临床常见的慢性消化疾病，有着发病率高、易反复且临床表现多样的特点。以咽喉不适、声音嘶哑、咳嗽等食管外症状为主要表现的GERD人群的诊断一直是临床难题。近年来，随着对胃食管反流病认识的不断加深及诊断技术的发展，临床诊断方法更加多样化。本文中笔者就目前几种常用的GERD临床诊断方法的新进展及未来可能用于食管外症状人群诊断的新技术进行汇总综述。

关键词: 胃食管反流病, 食管外症状, 动态反流监测, 基线阻抗, 唾液蛋白酶

Gastroesophageal reflux disease (GERD) is a common clinical chronic digestive system disease. It has the characteristics as high prevalence, easy recurrence and diverse clinical manifestations. The diagnosis of GERD with extra-esophageal manifestations as throat discomfort, cough and hoarseness has always been a difficult clinical problem. With the in-depth understanding of GERD and the continuous development of technology, clinical examinations become more diverse. In this paper, we summarize the developments of several commonly used examinations and novel technologies being used to diagnose people with GERD extra-esophageal symptoms in the future.

Key words: Gastroesophageal reflux disease, Extra-esophageal symptoms, Dynamic reflux monitoring, Baseline Impedance, Saliva pepsin

1	Eusebi LH, Ratnakumaran R, Yuan Y, et al. Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis [J]. Gut, 2018, 67(3): 430-440.
2	Tsoukali E, Sifrim D. Investigation of extraesophageal gastroesophageal reflux disease [J]. Ann Gastroenterol, 2013, 26(4): 290-295.
3	Martinucci I, Albano E, Marchi S, et al. Extra-esophageal presentation of gastroesophageal reflux disease: new understanding in a new era [J]. Minerva Gastroenterol Dietol. 2017, 63(3): 221-234.
4	Broderick R, Fuchs KH, Breithaupt W, et al. Clinical Presentation of Gastroesophageal Reflux Disease: A Prospective Study on Symptom Diversity and Modification of Questionnaire Application [J]. Dig Dis, 2020, 38(3): 188-195.
5	汪忠镐, 吴继敏, 胡志伟, 等. 中国胃食管反流病多学科诊疗共识 [J]. 中国医学前沿杂志(电子版), 2019, 11(9):30-56.
6	李进让. 咽喉反流性疾病诊断与治疗专家共识(2015年) [J/CD]. 中华耳鼻咽喉头颈外科杂志, 2016, 51(5):324-326.
7	Sandhu DS , Fass R . Current Trends in the Management of Gastroesophageal Reflux Disease [J]. Gut and Liver, 2018, 15, 12(1): 7-16.
8	中华医学会消化病学分会. 2020年中国胃食管反流病专家共识 [J/CD]. 中华消化杂志, 2020, 40(10):649-663.
9	Gyawali CP, Kahrilas PJ, Savarino E, et al. Modern diagnosis of GERD: the Lyon Consensus [J/CD]. Gut, 2018, 67(7): 1351-1362.
10	Vaezi MF, Sifrim D. Assessing Old and New Diagnostic Tests for Gastroesophageal Reflux Disease [J]. Gastroenterology, 2018, 154(2): 289-301.
11	Kia L, Pandolfino JE, Kahrilas PJ. Biomarkers of Reflux Disease [J]. Clin Gastroenterol Hepatol. 2016, 14(6): 790-797.
12	姜亚, 林琳. 食管上段胃黏膜异位的内镜特点及临床意义 [J]. 中华全科医师杂志, 2019, 18(9):885-888.
13	Chong VH, Jalihal A. Heterotopic gastric mucosal patch of the esophagus is associated with higher prevalence of laryngopharyngeal reflux symptoms [J]. Eur Arch Otorhinolaryngol. 2010, 267(11): 1793-1799.
14	Kahrilas P, Yadlapati R, Roman S. Emerging dilemmas in the diagnosis and management of gastroesophageal reflux disease [J]. F1000Res, 2017, 25(6):1748.
15	Banerjee R, Reddy DN. Enhanced endoscopic imaging and gastroesophageal reflux disease [J]. Indian Journal of Gastroenterology, 2011, 30(5): 193-200.
16	Lou Z, Lou Z. The clinical value of the RGB value of an image of the interarytenoid area for diagnosis of laryngopharyngeal reflux [J]. Am J Otolaryngol, 2018, 39(3): 362-363.
17	Frazzoni M, De Bortoli N, Frazzoni L, et al. Impedance-pH Monitoring for Diagnosis of Reflux Disease: New Perspectives [J]. Dig Dis Sci, 2017, 62(8): 1881-1889.
18	Roman S, Gyawali CP, Savarino E, et al. Ambulatory reflux monitoring for diagnosis of gastro-esophageal reflux disease: Update of the Porto consensus and recommendations from an international consensus group [J]. Neurogastroenterol Motil, 2017, 29(10): 1-15.
19	Zhang M, Tan N, Li Y, et al. Esophageal physiologic profiles within erosive esophagitis in China: Predominantly low-grade esophagitis with low reflux burden [J]. Neurogastroenterol Motil, 2019, 31(12): e 13702.
20	Abdul-Hussein M, Castell D. Symptom association latency during ambulatory reflux monitoring: a review of 1445 symptoms [J]. Dis Esophagus, 2017, 30(10): 1-6.
21	Schmulson MJ, Drossman DA. What Is New in Rome IV [J]. J Neurogastroenterol Motil, 2017, 30, 23(2): 151-163.
22	Patel A, Wang D, Sainani N, et al. Distal mean nocturnal baseline impedance on pH-impedance monitoring predicts reflux burden and symptomatic outcome in gastro-oesophageal reflux disease [J]. Aliment Pharmacol Ther, 2016, 44(8): 890-898.
23	Sakin YS, Vardar R, Sezgin B, et al. The diagnostic value of 24-hour ambulatory intraesophageal pH-impedance in patients with laryngopharyngeal reflux symptoms comparable with typical symptoms [J]. United European Gastroenterol J, 2017, 5(5): 632-640.
24	Frazzoni M, Savarino E, Bortoli N, et al. Analyses of the Post-reflux Swallow-induced Peristaltic Wave Index and Nocturnal Baseline Impedance Parameters Increase the Diagnostic Yield of Impedance-pH Monitoring of Patients With Reflux Disease [J]. Clin Gastroenterol Hepatol, 2016, 14(1): 40-46.
25	Xu H, Ye B, Ding Y, et al. Factors of Reflux Episodes With Post-reflux Swallowinduced Peristaltic Wave in Gastroesophageal Reflux Disease [J]. J Neurogastroenterol Motil. 2020, 30, 26(3): 378-383.
26	Kavitt RT, Lal P, Yuksel ES, et al. Esophageal Mucosal Impedance Pattern is Distinct in Patients With Extraesophageal Reflux Symptoms and Pathologic Acid Reflux. J Voice [J]. 2017, 31(3): 347-351.
27	Patel DA, Higginbotham T, Slaughter JC, et al. Development and Validation of a Mucosal Impedance Contour Analysis System to Distinguish Esophageal Disorders [J]. Gastroenterology, 2019, 156(6): 1617-1626.e1.
28	Iluyomade A, Olowoyeye A, Fadahunsi O, et al. Interference with daily activities and major adverse events during esophageal pH monitoring with bravo wireless capsule versus conventional intranasal catheter: a systematic review of randomized controlled trials [J]. Dis Esophagus, 2017, 1, 30(3): 1-9.
29	des Varannes SB, Mion F, Ducrotté P, et al. Simultaneous recordings of oesophageal acid exposure with conventional pH monitoring and a wireless system (Bravo) [J]. Gut, 2005, 54(12): 1682-1686.
30	陈嘉韦, 陈龙平, 李达周, 等. 无线食管 pH胶囊在咽喉反流诊断中的价值 [J]. 中华胃食管反流病电子杂志, 2015, 2(4):197-201.
31	程俊秀,熊玉玲,管祥栋,等. 动态 pH监测技术用于胃食管反流病诊断的研究进展 [J]. 国际消化病杂志, 2019, 39(6):385-388.
32	Vailati C, Mazzoleni G, Bondi S, et al. Oropharyngeal pH Monitoring for Laryngopharyngeal Reflux: Is It a Reliable Test Before Therapy? [J]. Journal of Voice, 2013, 27(1): 84-89.
33	Plocek A, Gębora-Kowalska B, Białek J, et al. Esophageal Impedance-pH Monitoring and Pharyngeal pH Monitoring in the Diagnosis of Extraesophageal Reflux in Children [J]. Gastroenterol Res Pract, 2019(3): 6271910.
34	Wilhelm D, Jell A , Feussner H, et al. Pharyngeal pH monitoring in gastrectomy patients-what do we really measure? [J]. United European Gastroenterol J, 2016, 4(4): 541-545.
35	Lee BE, Kim GH, Ryu DY, et al. Combined Dual Channel Impedance/pH-metry in Patients With Suspected Laryngopharyngeal Reflux [J]. J Neurogastroenterol Motil, 2010, 16(2): 157-165.
36	Ivashkin VT, Maev IV, Trukhmanov AS, et al. High resolution manometry and new classification of esophageal motility disorders [J]. Terapevticheskii arkhiv, 2018, 90(5): 93-100.
37	Vardar R, Sweis R, Anggiansah A, et al. Upper esophageal sphincter and esophageal motility in patients with chronic cough and reflux: assessment by high-resolution manometry [J]. Dis Esophagus, 2013, 26(3): 219-225.
38	Hirano I, Pandolfino JE, Boeckxstaens GE. Functional Lumen Imaging Probe for the Management of Esophageal Disorders: Expert Review From the Clinical Practice Updates Committee of the AGA Institute [J]. Clin Gastroenterol Hepatol, 2017, 15(3): 325-334.
39	Hayat JO, Gabieta-Somnez S, Yazaki E, et al. Pepsin in saliva for the diagnosis of gastro-oesophageal reflux disease [J]. Gut, 2015, 64(3): 373-380.
40	Johnston N, Dettmar PW, Bishwokarma B, et al. Activity/stability of human pepsin: implications for reflux attributed laryngeal disease [J]. The Laryngoscope, 2007, 117(6): 1036-1039.
41	Komatsu Y, Kelly LA, Zaidi AH, et al. Hypopharyngeal pepsin and Sep70 as diagnostic markers of laryngopharyngeal reflux: preliminary study [J]. Surgical Endoscopy, 2015, 29(5):1080-1087.
42	郭雪云,林连捷,王东旭,等. 胃食管反流病诊断新进展非侵入性唾液胃蛋白酶检测 [J]. 胃肠病学和肝病学杂志, 2017, 26(9):1066-1070.
43	Weitzendorfer M, Antoniou SA, Schredl P, et al. Pepsin and oropharyngeal pH monitoring to diagnose patients with laryngopharyngeal reflux [J]. Laryngoscope, 2020, 130(7): 1780-1786.

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