胃食管反流病检测方法的进展

Detection of gastroesophageal reflux disease:advances in methodology

胃食管反流病(gastroesophageal reflux disease,GERD)发病率逐年上升,其临床表现多样,多种检测手段可供选择以确定诊断.传统的检测手段不断更新完善,反流病问卷及PPI试验经典、简便而且有效,可用于GERD的初筛;内镜检查手段日趋更新,色素及放大内镜在临床中普遍应用,荧光内镜、窄光谱成像及共聚焦内镜应用于临床使人们对Barrett's食管及非糜烂性反流病的食管表现有了更新的认识,光学相干层析技术及频率域角分辨低相干干涉测量法被誉为"光活检"技术,正在逐步走向临床;24h食管pH监测及胆汁反流监测、食管测压等仍是目前临床中最常用的监测胃食管反流的方式,但不能对所有反流事件及食管各段的运动情况进行全面的监测,新的检测手段如食管内24hpH+阻抗监测、高分辨的食管测压分析等弥补了上述检查的不足,在临床中逐渐得到应用.本文对GERD诊断的相关检测方法进行了介绍与评价.

The incidence of gastroesophageal reflux disease （GERD） is increasing year by year.Currently,many methods are available for detection of GERD.Traditional detection methods,such as the reflux disease questionnaire and proton pump inhibitor test,are convenient and effective and can be used for primary screening of GERD.Endoscopy,chromoendoscopy,and magnification endoscopy have also been used widely in clinical detection of GERD.The usage of narrow-band imaging endoscopy,light-induced fluorescence endoscopy and confocal endoscopy offers new insight into the esophageal appearance of Barrett＇s esophagus and non-erosive reflux disease.Endoscopic optical coherence tomography and frequencyd omain angle-resolved low-coherence interferometry are optical biopsy techniques that will be used gradually in clinical practice.The 24-hour esophageal pH monitoring,bile reflux monitoring,and esophageal manometry are the most commonly used method for monitoring gastroesophageal reflux but can not be used to monitor all reflux events.The 24-hour multichannel intraluminal impedance measurement and high-resolution manometry can redeem the shortage of the above detections and have been used gradually in clinical diagnosis.In this paper,we review the advances in methodology for detection of GERD.