Basic Research Progress and Current Status of Clinical Diagnosis and Therapy for Gastroesophageal Reflux Disease_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 GUYue-lei , LIFeng , FANQiang , ZHANGLong-long ,  YANGSun-hu

Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 201900, China;

Corresponding author：

YANGSun-hu, Email: yangsh06@126.com

Keywords：

Gastroesophageal reflux disease; Pathogenesis; Extra-esophageal symptoms; Diagnosis; Therapy

DOI：

10.7507/1007-9424.20160361

Video：

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Objective To summarize basic research progress and current status of clinical diagnosis and therapy for gastroesophageal reflux disease. Method Related literatures were collected to review the pathogenesis, clinical manifestations, diagnosis and therapy of gastroesophageal reflux disease. Results Gastroesophageal reflux disease was caused by many factors, such as hiatus hernia, hypotensive lower esophageal sphincter pressure, acid pocket, prolonged esophageal clearance, and delayed gastric emptying. Extra-esophageal symptoms was a common clinical presentation to gastroesophageal reflux disease. The diagnosis methods for gastroesophageal reflux disease included the symptom observation, gastroscopy examination, 24 h pH monitoring of esophageal, proton pump inhibitor test, questionnaire of gastroesophageal reflux disease and so on. The laparoscopic fundoplication could essentially treat the pathophysiologic abnormalities of gastroesophageal reflux disease, which had an obvious curative effect and wide application prospect. Conclusion Pathogenesis, diagnosis, and therapy of gastroesophageal reflux disease are associated with multiple factors, which is still controversial and remains to be further studied.

Citation： GUYue-lei, LIFeng, FANQiang, ZHANGLong-long, YANGSun-hu. Basic Research Progress and Current Status of Clinical Diagnosis and Therapy for Gastroesophageal Reflux Disease. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(11): 1413-1417. doi: 10.7507/1007-9424.20160361 Copy

1.	季锋, 汪忠镐. 2013美国胃肠病学院胃食管反流病诊断和管理指南解读. 中华胃食管反流病电子杂志, 2015, 2(2):70-74.
2.	El-Serag HB, Sweet S, Winchester CC, et al. Update on the epidemio-logy of gastro-oesophageal reflux disease:a systematic review. Gut, 2014, 63(6):871-880.
3.	Allison PR. Reflux esophagitis, sliding hiatal hernia, and the anatomy of repair. Surg Gynecol Obstet, 1951, 92(4):419-431.
4.	Kohn GP, Price RR, DeMeester SR, et al. Guidelines for the manage-ment of hiatal hernia. Surg Endosc, 2013, 27(12):4409-4428.
5.	Dean C, Etienne D, Carpentier B, et al. Hiatal hernias. Surg Radiol Anat, 2012, 34(4):291-299.
6.	van Herwaarden MA, Samsom M, Smout AJ. Excess gastroesopha-geal reflux in patients with hiatus hernia is caused by mechanisms other than transient LES relaxations. Gastroenterology, 2000, 119(6):1439-1446.
7.	Mikami DJ, Murayama KM. Physiology and pathogenesis of gastroesophageal reflux disease. Surg Clin North Am, 2015, 95(3):515-525.
8.	Jones MP, Sloan SS, Jovanovic B, et al. Impaired egress rather than increased access:an important independent predictor of erosive oesophagitis. Neurogastroenterol Motil, 2002, 14(6):625-631.
9.	van Herwaarden MA, Samsom M, Smout AJ. The role of hiatus hernia in gastro-oesophageal reflux disease. Eur J Gastroenterol Hepatol, 2004, 16(9):831-835.
10.	Kahrilas PJ, Lin S, Chen J, et al. The effect of hiatus hernia on gast-rooesophageal junction pressure. Gut, 1999, 44(4):476-482.
11.	Pandolfino JE, Shi G, Trueworthy B, et al. Esophagogastric junction opening during relaxation distinguishes nonhernia reflux patients, hernia patients, and normal subjects. Gastroenterology, 2003, 125(4):1018-1024.
12.	Kahrilas PJ, Shi G, Manka M, et al. Increased frequency of transient lower esophageal sphincter relaxation induced by gastric distention in reflux patients with hiatal hernia. Gastroenterology, 2000, 118(4):688-695.
13.	Boeckxstaens GE, Rohof WO. Pathophysiology of gastroesophageal reflux disease. Gastroenterol Clin North Am, 2014, 43(1):15-25.
14.	王瑞, 唐艳萍. 胃食管反流病病因病机研究进展. 中国中西医结合外科杂志, 2015, 21(2):201-203.
15.	De Giorgi F, Palmiero M, Esposito I, et al. Pathophysiology of gastro-oesophageal reflux disease. Acta Otorhinolaryngol Ital, 2006, 26(5):241-246.
16.	Hoshino M, Sundaram A, Mittal SK. Role of the lower esophageal sphincter on acid exposure revisited with high-resolution manometry. J Am Coll Surg, 2011, 213(6):743-750.
17.	Nicodeme F, Pipa-Muniz M, Khanna K, et al. Quantifying esopha-gogastric junction contractility with a novel HRM topographic metric, the EGJ-Contractile Integral:normative values and preliminary evaluation in PPI non-responders. Neurogastroenterol Motil, 2014, 26(3):353-360.
18.	van Hoeij FB, Bredenoord AJ. Clinical application of esophageal high-resolution manometry in the diagnosis of esophageal motility disorders. J Neurogastroenterol Motil, 2016, 22(1):6-13.
19.	Herregods TV, Bredennoord AJ, Smout AJ. Pathophysiology of gastroesophageal reflux disease:new understanding in a new era. Neurogastroenterol Motil, 2015, 27(9):1202-1213.
20.	Piche T, des Varannes SB, Sacher-Huvelin S, et al. Colonic fermenta-tion influences lower esophageal sphincter function in gastroesopha-geal reflux disease. Gastroenterology, 2003, 124(4):894-902.
21.	Trudgill NJ, Riley SA. Transient lower esophageal sphincter relaxa-tions are no more frequent in patients with gastroesophageal reflux disease than in asymptomatic volunteers. Am J Gastroenterol, 2001, 96(9):2569-2574.
22.	Fletcher J, Wirz A, Young J, et al. Unbuffered highly acidic gastric juice exists at the gastroesophageal junction after a meal. Gastroen-terology, 2001, 121(4):775-783.
23.	Clarke AT, Wirz AA, Manning JJ, et al. Severe reflux disease is associated with an enlarged unbuffered proximal gastric acid pocket. Gut, 2008, 57(3):292-297.
24.	Rohof WO, Bennink RJ, de Ruigh AA, et al. Effect of azithromycin on acid reflux, hiatus hernia and proximal acid pocket in the postprandial period. Gut, 2012, 61(12):1670-1677.
25.	Rohof WO, Bennink RJ, Boeckxstaens GE. Proton pump inhibitors reduce the size and acidity of the acid pocket in the stomach. Clin Gastroenterol Hepatol, 2014, 12(7):1101-1107.
26.	Vinjirayer E, Gonzalez B, Brensinger C, et al. Ineffective motility is not a marker for gastroesophageal reflux disease. Am J Gastroenterol, 2003, 98(4):771-776.
27.	Simren M, Silny J, Holloway R, et al. Relevance of ineffective oesophageal motility during oesophageal acid clearance. Gut, 2003, 52(6):784-790.
28.	Chen CL, Yi CH, Liu TT, et al. Altered sensorimotor responses to esophageal acidification in older adults with GERD. Scand J Gastioen-terol, 2010, 45(10):1150-1155.
29.	Penagini R, Bravi I. The role of delayed gastric emptying and impa-ired oesophageal body motility. Best Pract Res Clin Gastroenterol, 2010, 24(6):831-845.
30.	Gourcerol G, Benanni Y, Boueyre E, et al. Influence of gastric emp-tying on gastro-esophageal reflux:a combined pH-impedance study. Neurogastroenterol Motil, 2013, 25(10):800-e634.
31.	Kessing BF, Smout AJ, Bennink RJ, et al. Prucalopride decreases esophageal acid exposure and accelerates gastric emptying in healthy subjects. Neurogastroenterol Motil, 2014, 26(8):1079-1086.
32.	汪忠镐, 陈秀, 韩冰, 等. 胃食管反流病引起"顽固性哮喘"以致气胸一例报告. 临床误诊误治, 2006, 19(11):8-9.
33.	Allen GB, Ledair TR, von Reyn J, et al. Acid aspiration-induced airways hyperresponsiveness in mice. J Appl Physiol, 2009, 107(6):1763-1770.
34.	汪忠镐, 来运钢, 吴继敏, 等. 胃食管喉气管反流动物实验初步验证. 临床误诊误治, 2007, 20(12):1-2.
35.	汪忠镐. 食管反流与呼吸道疾病. 北京:人民卫生出版社, 2010:2-6.
36.	化召辉, 李震, 汪忠镐. 食管裂孔疝与呼吸道症状关系的研究进展. 中国普外基础与临床杂志, 2014, 21(4):519-523.
37.	Henry MA. Diagnosis and management of gastroesophageal reflux disease. Arg Bras Cir Dig, 2014, 27(3):210-215.
38.	Kasap E, Zeybel M, Aslk G, et al. Correlation among standard endoscopy, narrow band imaging, and histopathological findings in the diagnosis of nonerosive reflux disease. J Gastrointestin Liver Dis, 2011, 20(2):127-130.
39.	Sharma P, Hawes RH, Bansal A, et al. Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett's oesophagus:a prospective, international, randomized controlled trial. Gut, 2013, 62(1):15-21.
40.	Hirano I, Richter JE. ACG practice guidelines:esophageal refluxtes-ting. Am J Gastroenterol, 2007, 102(3):668-685.
41.	Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol, 2013, 108(3):308-328.
42.	Jonasson C, Wernersson B, Hoff DA, et al. Validation of the GerdQ questionnaire for the diagnosis of gastro-oesophageal reflux disease. Aliment Pharmacol Ther, 2013, 37(5):564-572.
43.	王志, 张成, 王俭, 等. GerdQ量表在胃食管反流病诊断中的应用. 中华胃食管反流病电子杂志, 2014, 1(1):36-38.
44.	Sifrim D, Zerbib F. Diagnosis and management of patients with reflux symptoms refractory to proton pump inhibitors. Gut, 2012, 61(9):1340-1354.
45.	胡志伟, 吴继敏, 汪忠镐, 等. 胃食管喉气管综合征的再认识和胃镜下射频术治疗胃食管反流病的进展. 中国微创外科杂志, 2015, 15(6):558-562.
46.	Stefanidis D, Hope WW, Kohn GP, et al. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc, 2010, 24(11):2647-2669.
47.	Zhang CC, Wang ZG, Wu JM, et al. The laparoscopic nissen fundo-plication eliminates obstructive sleep apnea syndrome due to gastro-esophageal reflux disease. Indian J Surg, 2013, 75(Suppl 1):326-328.
48.	张成, 克力木, 汪忠镐. 胃食管反流病如何选择抗反流术式. 外科理论与实践, 2016, 21(2):114-117.
49.	Shapey IM, Aqrawal S, Peacock A, et al. A prospective cross-sectional study of laparoscopic subtotal Lind fundoplication for gastro-oesop-hageal reflux disease-a durable and effective anti-reflux procedure. Int J Surg, 2015, 13:257-260.
50.	Thompson SK, Watson DI. What is the best anti-reflux operation? All fundoplications are not created equal. World J Surg, 2015, 39(4):997-999.
51.	Ruiz de Angulo D, Ortiz MA, Martinez de Haro LF. Side effects of proton-pump inhibitors:another reason to indicate anti-reflux surgery for Barrett,s esophagus? Cir Esp, 2014, 92(5):303-304.
52.	Gawron AJ, French DD, Pandolfino JE, et al. Economic evaluations of gastroesophageal reflux disease medical management. Pharma-coeconomics, 2014, 32(8):745-758.

1. 季锋, 汪忠镐. 2013美国胃肠病学院胃食管反流病诊断和管理指南解读. 中华胃食管反流病电子杂志, 2015, 2(2):70-74.
2. El-Serag HB, Sweet S, Winchester CC, et al. Update on the epidemio-logy of gastro-oesophageal reflux disease:a systematic review. Gut, 2014, 63(6):871-880.
3. Allison PR. Reflux esophagitis, sliding hiatal hernia, and the anatomy of repair. Surg Gynecol Obstet, 1951, 92(4):419-431.
4. Kohn GP, Price RR, DeMeester SR, et al. Guidelines for the manage-ment of hiatal hernia. Surg Endosc, 2013, 27(12):4409-4428.
5. Dean C, Etienne D, Carpentier B, et al. Hiatal hernias. Surg Radiol Anat, 2012, 34(4):291-299.
6. van Herwaarden MA, Samsom M, Smout AJ. Excess gastroesopha-geal reflux in patients with hiatus hernia is caused by mechanisms other than transient LES relaxations. Gastroenterology, 2000, 119(6):1439-1446.
7. Mikami DJ, Murayama KM. Physiology and pathogenesis of gastroesophageal reflux disease. Surg Clin North Am, 2015, 95(3):515-525.
8. Jones MP, Sloan SS, Jovanovic B, et al. Impaired egress rather than increased access:an important independent predictor of erosive oesophagitis. Neurogastroenterol Motil, 2002, 14(6):625-631.
9. van Herwaarden MA, Samsom M, Smout AJ. The role of hiatus hernia in gastro-oesophageal reflux disease. Eur J Gastroenterol Hepatol, 2004, 16(9):831-835.
10. Kahrilas PJ, Lin S, Chen J, et al. The effect of hiatus hernia on gast-rooesophageal junction pressure. Gut, 1999, 44(4):476-482.
11. Pandolfino JE, Shi G, Trueworthy B, et al. Esophagogastric junction opening during relaxation distinguishes nonhernia reflux patients, hernia patients, and normal subjects. Gastroenterology, 2003, 125(4):1018-1024.
12. Kahrilas PJ, Shi G, Manka M, et al. Increased frequency of transient lower esophageal sphincter relaxation induced by gastric distention in reflux patients with hiatal hernia. Gastroenterology, 2000, 118(4):688-695.
13. Boeckxstaens GE, Rohof WO. Pathophysiology of gastroesophageal reflux disease. Gastroenterol Clin North Am, 2014, 43(1):15-25.
14. 王瑞, 唐艳萍. 胃食管反流病病因病机研究进展. 中国中西医结合外科杂志, 2015, 21(2):201-203.
15. De Giorgi F, Palmiero M, Esposito I, et al. Pathophysiology of gastro-oesophageal reflux disease. Acta Otorhinolaryngol Ital, 2006, 26(5):241-246.
16. Hoshino M, Sundaram A, Mittal SK. Role of the lower esophageal sphincter on acid exposure revisited with high-resolution manometry. J Am Coll Surg, 2011, 213(6):743-750.
17. Nicodeme F, Pipa-Muniz M, Khanna K, et al. Quantifying esopha-gogastric junction contractility with a novel HRM topographic metric, the EGJ-Contractile Integral:normative values and preliminary evaluation in PPI non-responders. Neurogastroenterol Motil, 2014, 26(3):353-360.
18. van Hoeij FB, Bredenoord AJ. Clinical application of esophageal high-resolution manometry in the diagnosis of esophageal motility disorders. J Neurogastroenterol Motil, 2016, 22(1):6-13.
19. Herregods TV, Bredennoord AJ, Smout AJ. Pathophysiology of gastroesophageal reflux disease:new understanding in a new era. Neurogastroenterol Motil, 2015, 27(9):1202-1213.
20. Piche T, des Varannes SB, Sacher-Huvelin S, et al. Colonic fermenta-tion influences lower esophageal sphincter function in gastroesopha-geal reflux disease. Gastroenterology, 2003, 124(4):894-902.
21. Trudgill NJ, Riley SA. Transient lower esophageal sphincter relaxa-tions are no more frequent in patients with gastroesophageal reflux disease than in asymptomatic volunteers. Am J Gastroenterol, 2001, 96(9):2569-2574.
22. Fletcher J, Wirz A, Young J, et al. Unbuffered highly acidic gastric juice exists at the gastroesophageal junction after a meal. Gastroen-terology, 2001, 121(4):775-783.
23. Clarke AT, Wirz AA, Manning JJ, et al. Severe reflux disease is associated with an enlarged unbuffered proximal gastric acid pocket. Gut, 2008, 57(3):292-297.
24. Rohof WO, Bennink RJ, de Ruigh AA, et al. Effect of azithromycin on acid reflux, hiatus hernia and proximal acid pocket in the postprandial period. Gut, 2012, 61(12):1670-1677.
25. Rohof WO, Bennink RJ, Boeckxstaens GE. Proton pump inhibitors reduce the size and acidity of the acid pocket in the stomach. Clin Gastroenterol Hepatol, 2014, 12(7):1101-1107.
26. Vinjirayer E, Gonzalez B, Brensinger C, et al. Ineffective motility is not a marker for gastroesophageal reflux disease. Am J Gastroenterol, 2003, 98(4):771-776.
27. Simren M, Silny J, Holloway R, et al. Relevance of ineffective oesophageal motility during oesophageal acid clearance. Gut, 2003, 52(6):784-790.
28. Chen CL, Yi CH, Liu TT, et al. Altered sensorimotor responses to esophageal acidification in older adults with GERD. Scand J Gastioen-terol, 2010, 45(10):1150-1155.
29. Penagini R, Bravi I. The role of delayed gastric emptying and impa-ired oesophageal body motility. Best Pract Res Clin Gastroenterol, 2010, 24(6):831-845.
30. Gourcerol G, Benanni Y, Boueyre E, et al. Influence of gastric emp-tying on gastro-esophageal reflux:a combined pH-impedance study. Neurogastroenterol Motil, 2013, 25(10):800-e634.
31. Kessing BF, Smout AJ, Bennink RJ, et al. Prucalopride decreases esophageal acid exposure and accelerates gastric emptying in healthy subjects. Neurogastroenterol Motil, 2014, 26(8):1079-1086.
32. 汪忠镐, 陈秀, 韩冰, 等. 胃食管反流病引起"顽固性哮喘"以致气胸一例报告. 临床误诊误治, 2006, 19(11):8-9.
33. Allen GB, Ledair TR, von Reyn J, et al. Acid aspiration-induced airways hyperresponsiveness in mice. J Appl Physiol, 2009, 107(6):1763-1770.
34. 汪忠镐, 来运钢, 吴继敏, 等. 胃食管喉气管反流动物实验初步验证. 临床误诊误治, 2007, 20(12):1-2.
35. 汪忠镐. 食管反流与呼吸道疾病. 北京:人民卫生出版社, 2010:2-6.
36. 化召辉, 李震, 汪忠镐. 食管裂孔疝与呼吸道症状关系的研究进展. 中国普外基础与临床杂志, 2014, 21(4):519-523.
37. Henry MA. Diagnosis and management of gastroesophageal reflux disease. Arg Bras Cir Dig, 2014, 27(3):210-215.
38. Kasap E, Zeybel M, Aslk G, et al. Correlation among standard endoscopy, narrow band imaging, and histopathological findings in the diagnosis of nonerosive reflux disease. J Gastrointestin Liver Dis, 2011, 20(2):127-130.
39. Sharma P, Hawes RH, Bansal A, et al. Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett's oesophagus:a prospective, international, randomized controlled trial. Gut, 2013, 62(1):15-21.
40. Hirano I, Richter JE. ACG practice guidelines:esophageal refluxtes-ting. Am J Gastroenterol, 2007, 102(3):668-685.
41. Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol, 2013, 108(3):308-328.
42. Jonasson C, Wernersson B, Hoff DA, et al. Validation of the GerdQ questionnaire for the diagnosis of gastro-oesophageal reflux disease. Aliment Pharmacol Ther, 2013, 37(5):564-572.
43. 王志, 张成, 王俭, 等. GerdQ量表在胃食管反流病诊断中的应用. 中华胃食管反流病电子杂志, 2014, 1(1):36-38.
44. Sifrim D, Zerbib F. Diagnosis and management of patients with reflux symptoms refractory to proton pump inhibitors. Gut, 2012, 61(9):1340-1354.
45. 胡志伟, 吴继敏, 汪忠镐, 等. 胃食管喉气管综合征的再认识和胃镜下射频术治疗胃食管反流病的进展. 中国微创外科杂志, 2015, 15(6):558-562.
46. Stefanidis D, Hope WW, Kohn GP, et al. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc, 2010, 24(11):2647-2669.
47. Zhang CC, Wang ZG, Wu JM, et al. The laparoscopic nissen fundo-plication eliminates obstructive sleep apnea syndrome due to gastro-esophageal reflux disease. Indian J Surg, 2013, 75(Suppl 1):326-328.
48. 张成, 克力木, 汪忠镐. 胃食管反流病如何选择抗反流术式. 外科理论与实践, 2016, 21(2):114-117.
49. Shapey IM, Aqrawal S, Peacock A, et al. A prospective cross-sectional study of laparoscopic subtotal Lind fundoplication for gastro-oesop-hageal reflux disease-a durable and effective anti-reflux procedure. Int J Surg, 2015, 13:257-260.
50. Thompson SK, Watson DI. What is the best anti-reflux operation? All fundoplications are not created equal. World J Surg, 2015, 39(4):997-999.
51. Ruiz de Angulo D, Ortiz MA, Martinez de Haro LF. Side effects of proton-pump inhibitors:another reason to indicate anti-reflux surgery for Barrett,s esophagus? Cir Esp, 2014, 92(5):303-304.
52. Gawron AJ, French DD, Pandolfino JE, et al. Economic evaluations of gastroesophageal reflux disease medical management. Pharma-coeconomics, 2014, 32(8):745-758.

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Basic Research Progress and Current Status of Clinical Diagnosis and Therapy for Gastroesophageal Reflux Disease

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