胃食管反流病及反流样表型：运用里昂共识2.0指导临床诊疗方法

摘要(中文译文)

胃食管反流病（GERD）在全球范围内普遍存在，但仅凭令人困扰的症状不足以作出明确诊断。蒙特利尔共识引入了基于症状的GERD定义，并确定了该病的黏膜损伤表型。里昂共识采纳了黏膜损伤表现，并定义了异常反流负荷标准，用于明确GERD的诊断。采用罗马V标准诊断食管脑-肠轴互动障碍（E-DGBI）需要排除GERD，这一点在里昂共识2.0标准中亦有阐述。综合运用这些不同的标准，可以在具有令人困扰的反流样症状的患者中识别出不同的表型。黏膜损伤表型最初由蒙特利尔共识定义，需要反流管理以促进食管炎愈合从而改善症状，并进行监测以识别和预防GERD并发症，包括巴雷特食管和食管腺癌。异常反流负荷表型需要反流管理以改善症状。E-DGBI表型需要对每种功能性疾病进行特异性管理以缓解症状。过度警觉和症状特异性焦虑可与所有表型重叠，且E-DGBI可与明确GERD共存。因此，蒙特利尔、里昂和罗马标准之间存在复杂的相互关系，有助于评估令人困扰的症状，且各标准中的概念有助于对患者进行准确的表型分型和优化管理。

Abstract

Gastroesophageal reflux disease (GERD) is common worldwide, but troublesome symptoms alone are not sufficient for a conclusive diagnosis. The Montreal Consensus introduced a symptom-based definition of GERD and defined mucosal injury phenotypes of the disease. The Lyon Consensus adapted mucosal injury findings as well as defined abnormal reflux burden criteria for the diagnosis of conclusive GERD. The diagnosis of esophageal disorders of gut-brain interaction (E-DGBI) using Rome V criteria requires exclusion of GERD, which is also described in the Lyon Consensus 2.0 criteria. Collectively utilizing these various criteria, distinct phenotypes can be identified in patients with troublesome reflux-like symptoms. The mucosal injury phenotype, initially defined by the Montreal Consensus, requires reflux management for healing of esophagitis to improve symptoms, and surveillance to identify and prevent GERD complications including Barrett's esophagus and esophageal adenocarcinoma. The abnormal reflux burden phenotype requires reflux management for symptom improvement. The E-DGBI phenotype requires specific management of each of the functional disorders for symptom relief. Hypervigilance and symptom-specific anxiety can overlap with all the phenotypes, and E-DGBI can coexist with conclusive GERD. Therefore, there are intricate interrelationships between Montreal, Lyon and Rome criteria that aid evaluation of troublesome symptoms, and concepts from each of these contribute to accurate phenotyping and optimal management of patients.

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