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摘要:
2023年9月, 《胃食管反流病现代诊断的更新: 里昂共识2.0》于线上发布。其提出了23条共识声明, 更新了胃食管反流病(gastro-esophageal reflux disease, GERD)的现代定义、优化了GERD的诊断和管理流程, 为GERD诊疗提供了最新依据。该国际性共识基于评估原版共识发布以来的高质量研究而制订, 但由于循证证据的局限性, 且不同国家的国情、人群、经济水平等存有差异, 有必要对其在我国的适用性进行解读, 以期更好地促进共识内容传播和落地, 并为患者提供更符合临床实践的指导意见。
Abstract:Updates to the modern diagnosis of GERD: Lyon consensus 2.0 was published online in September 2023. It presents 23 consensus statements that update the modern definition of gastro-esophageal reflux disease (GERD) and optimize the diagnosis and management of GERD, providing an up-to-date basis for the diagnosis and treatment of GERD. The international consensus is based on the evaluation of studies conducted since the original consensus was published. However, due to the limitations of evidence-based evidence and the differences in national conditions, populations, and economic levels of different countries, it is necessary to interpret its applicability in China, so as to better promote the dissemination of its content and its implementation, and provide patients with the most appropriate guidance for clinical practice.
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作者贡献：王佳丽负责文献检索、论文初稿撰写；李晓红、裴文婧负责论文修订；李军祥负责论文审校。利益冲突：所有作者均声明不存在利益冲突
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表 1 《里昂共识2.0》制订的共识意见
Table 1 Lyon consensus 2.0 statements
序号 推荐意见 专家同意率(%) 1 现代可操作的GERD的定义是在有相应GERD症状的情况下，内镜检查发现确凿反流相关病理证据，和/或反流监测异常(根据里昂共识阈值) 94 2 有典型GERD症状即可进行抗胃酸分泌药物试验，但建议对于所有其他非典型症状患者和PPI无应答者在GERD侵入性治疗前或长期药物治疗前，进行前期食管检查 89 3 GERD典型症状包括胃灼热、食管胸痛和反流 100 4 嗳气与反流的关系是可变的，嗳气可能是反流病理生理的一部分 89 5 慢性咳嗽和喘息与反流病理生理的关系较弱，但仍然存在可能性 83 6 在无典型症状的情况下，声音嘶哑、癔球感、恶心、腹痛和其他消化不良症状与反流病理生理关系可能较弱 95 7 LA分类B、C和D级食管炎，活检证实Barrett食管和消化性狭窄是GERD的确凿证据 94 8 为最大限度提高诊断率，对于未经证实的GERD，应在停止PPI试验2~4周后进行内镜检查 83 9 在优化PPI治疗期间，LA分类B、C和D级食管炎和复发性消化性狭窄提示存在难治性GERD 89 10 如有条件，在抗胃酸分泌治疗后进行延长无线pH监测是未经证实GERD的首选诊断工具，监测持续时间为96 h的诊断率最高 90 11 在未证实GERD的情况下，当有典型反流症状并伴过度嗳气、疑诊反刍现象，及评估肺部症状是否与GERD有关时，抗胃酸分泌治疗后的动态pH阻抗监测具有诊断价值 85 12 在已证实GERD的情况下，尽管接受了优化PPI治疗但症状仍持续存在时，动态pH阻抗监测具有诊疗价值 94 13 在无线pH监测时期内，若AET均＜4.0%且反流症状呈阴性，可排除GERD 100 14 若AET＞6.0%且持续时间≥2 d，可诊断为GERD，并支持GERD的治疗 89 15 若AET＜4.0%但在所有监测时期内反流-症状相关性为阳性，则符合反流超敏反应的标准 94 16 任何不符合GERD、反流超敏反应或正常标准的延长无线pH监测结果均被认为是GERD的不确定证据 83 17 在未服用PPI的情况下进行动态pH阻抗监测，若总AET＞6%可诊断GERD，并支持GERD的治疗 94 18 总反流发作＜40次/d可作为排除GERD的辅助证据 94 19 在未服用PPI的情况下，总反流发作40~80次/d是GERD的不确定证据 100 20 总反流发作＞80次/d是GERD的辅助证据 100 21 关于直立与仰卧位反流发作次数的阈值及酸性与非酸性反流事件的阈值，目前还无足够的数据将这些研究结果纳入临床共识 94 22 在进行优化的抗反流治疗方案时，AET＞4.0%和总反流发作＞80次/d的组合是可操作难治性GERD的证据 95 23 基线阻抗＜1500 Ω是GERD的辅助证据，而基线阻抗＞2500 Ω是排除病理性GERD的证据 90 GERD(gastro-esophageal reflux disease)：胃食管反流病；LA(Los Angeles)：洛杉矶；PPI(proton pump inhibitor)质子泵抑制剂；AET(acid exposure time)：酸暴露时间 
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