2025版《美国胃肠内镜学会胃食管反流病诊疗指南》解读

doi:10.16139/j.1007-9610.2025.05.03

摘要/Abstract

摘要：

2025年2月发布的《美国胃肠内镜学会胃食管反流病诊疗指南》基于近十年大量循证医学证据，系统更新了内镜检查的适应证、高质量内镜检查标准和多维度管理策略，重点阐述内镜干预在胃食管反流病（GERD）诊疗的新定位，旨在为临床医师提供一份兼具科学性与实践价值的权威指导工具。

关键词: 胃食管反流病, 美国胃肠内镜学会, 指南解读

Abstract:

Released in February 2025, American Society for Gastrointestinal Endoscopy（ASGE） guideline on the diagnosis and management of gastroesophageal reflux disease(GERD), is based on a large body of evidence-based medical evidence over the past decade. It has systematically updated the indications for endoscopic examination, standards for high-quality endoscopic examination, and multidimensional management strategies, while focusing on elucidating the new role of endoscopic intervention in the diagnosis and treatment of GERD. The guideline aimed to provide clinicians with an authoritative guiding tool that integrates both scientific and practical value.

Key words: Gastroesophageal reflux disease(GERD), American Society for Gastrointestinal Endoscopy(ASGE), Guidelines interpretation

中图分类号:

R573

桑怀鸣, 吴高珏, 汤玉蓉. 2025版《美国胃肠内镜学会胃食管反流病诊疗指南》解读[J]. 外科理论与实践, 2025, 30(05): 385-391.

SANG Huaiming, WU Gaojue, TANG Yurong. Interpretation of the 2025 American Society for Gastrointestinal Endoscopy guideline on diagnosis and management of GERD[J]. Journal of Surgery Concepts & Practice, 2025, 30(05): 385-391.

图/表 1

参考文献 39

[1]	DELSHAD S D, ALMARIO C V, CHEY W D, et al. Prevalence of gastroesophageal reflux disease and proton pump inhibitor-refractory symptoms[J]. Gastroenterology, 2020, 158(5):1250-1261.e1252. doi: S0016-5085(19)41941-0 pmid: 31866243
[2]	EL-SERAG H B, SWEET S, WINCHESTER C C, et al. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review[J]. Gut, 2014, 63(6):871-880. doi: 10.1136/gutjnl-2012-304269 URL
[3]	VAKIL N, VAN ZANTEN S V, KAHRILAS P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus[J]. Am J Gastroenterol, 2006, 101(8):1900-1920. doi: 10.1111/j.1572-0241.2006.00630.x pmid: 16928254
[4]	MARET-OUDA J, MARKAR S R, LAGERGREN J. Gastroesophageal reflux disease: a review[J]. JAMA, 2020, 324(24):2536-2547. doi: 10.1001/jama.2020.21360 URL
[5]	KATZ P O, GERSON L B, VELA M F. Guidelines for the diagnosis and management of gastroesophageal reflux disease[J]. Am J Gastroenterol, 2013, 108(3):308-328. doi: 10.1038/ajg.2012.444 pmid: 23419381
[6]	Committee ASOP, DESAI M, RUAN W, et al. American Society for Gastrointestinal Endoscopy guideline on the diagnosis and management of GERD: summary and recommendations[J]. Gastrointest Endosc, 2025, 101(2):267-284. doi: 10.1016/j.gie.2024.10.008 pmid: 39692638
[7]	SALMINEN P, GRONROOS S, HELMIO M, et al. Effect of laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass on weight loss, comorbidities, and reflux at 10 years in adult patients with obesity: the SLEEVEPASS randomized clinical trial[J]. JAMA Surg, 2022, 157(8):656-666. doi: 10.1001/jamasurg.2022.2229 URL
[8]	SEBASTIANELLI L, BENOIS M, VANBIERVLIET G, et al. Systematic endoscopy 5 years after sleeve gastrectomy results in a high rate of Barrett's esophagus: results of a multicenter study[J]. Obes Surg, 2019, 29(5):1462-1469. doi: 10.1007/s11695-019-03704-y
[9]	SORICELLI E, CASELLA G, BAGLIO G, et al. Lack of correlation between gastroesophageal reflux disease symptoms and esophageal lesions after sleeve gastrectomy[J]. Surg Obes Relat Dis, 2018, 14(6):751-756. doi: S1550-7289(18)30087-X pmid: 29571635
[10]	CSENDES A, ORELLANA O, MARTINEZ G, et al. Clinical, endoscopic, and histologic findings at the distal esophagus and stomach before and late (10.5 years) after laparoscopic sleeve gastrectomy: results of a prospective study with 93% follow-up[J]. Obes Surg, 2019, 29(12):3809-3817. doi: 10.1007/s11695-019-04054-5
[11]	DIMBEZEL V, NEDELCU A, DANAN M, et al. Endoscopic findings 5 years following sleeve gastrectomy[J]. Obes Surg, 2020, 30(10):3847-3851. doi: 10.1007/s11695-020-04757-0
[12]	QUMSEYA B J, QUMSIYEH Y, PONNIAH S A, et al. Barrett's esophagus after sleeve gastrectomy: a systematic review and meta-analysis[J]. Gastrointest Endosc, 2021, 93(2):343-352.e2. doi: 10.1016/j.gie.2020.08.008 pmid: 32798535
[13]	中国医师协会外科医师分会肥胖和代谢病外科专家工作组, 中国医师协会外科医师分会胃食管反流疾病诊疗外科专家工作组, 日本肥胖治疗学会, 等. 袖状胃切除术患者胃食管反流病诊治中日韩专家上海共识(2024版)[J]. 中国普通外科杂志, 2024, 33(10):1547-1566.
	Chinese Society for Obesity and Metabolic Disease Surgery, Chinese Society for Gastroesophageal Reflux Disease Surgery, Japanese Society for Treatment of Obesity, et al. The Shanghai consensus of Chinese, Japanese, and Korean experts on the diagnosis and treatment of gastroesophageal reflux disease in patients undergoing sleeve gastrectomy (2024 edition)[J]. Chin J Gen Surg, 2024, 33(10):1547-1566.
[14]	VESPA E, PELLEGATTA G, CHANDRASEKAR V T, et al. Long-term outcomes of peroral endoscopic myotomy for achalasia: a systematic review and meta-analysis[J]. Endoscopy, 2023, 55(2):167-175. doi: 10.1055/a-1894-0147 URL
[15]	YANG D, BECHARA R, DUNST C M, et al. AGA clinical practice update on advances in Per-Oral Endoscopic Myotomy (POEM) and remaining questions-what we have learned in the past decade: expert review[J]. Gastroenterology, 2024, 167(7):1483-1490. doi: 10.1053/j.gastro.2024.08.038 URL
[16]	ASGE Standards of Practice Committee, COELHO-PRABHU N, FORBES N, et al. Adverse events associated with EGD and EGD-related techniques[J]. Gastrointest Endosc, 2022, 96(3):389-401.e1. doi: 10.1016/j.gie.2022.04.024 URL
[17]	BOYS J A, AZADGOLI B, MARTINEZ M, et al. Ade-quacy of EGD reporting: a review of 100 reports from 100 endoscopists[J]. J Gastrointest Surg, 2021, 25(5):1117-1123. doi: 10.1007/s11605-020-04634-2 URL
[18]	MATHUS-VLIEGEN E M, VAN WEEREN M, VAN EERTEN P V. Los function and obesity: the impact of untreated obesity, weight loss, and chronic gastric balloon distension[J]. Digestion, 2003, 68(2-3):161-168. doi: 10.1159/000075525 URL
[19]	MATHUS-VLIEGEN E M, TYGAT G N. Gastro-oesophageal reflux in obese subjects: influence of overweight, weight loss and chronic gastric balloon distension[J]. Scand J Gastroenterol, 2002, 37(11):1246-1252. doi: 10.1080/003655202761020498 URL
[20]	SINGH M, LEE J, GUPTA N, et al. Weight loss can lead to resolution of gastroesophageal reflux disease symptoms: a prospective intervention trial[J]. Obesity (Silver Spring), 2013, 21(2):284-290. doi: 10.1002/oby.v21.2 URL
[21]	KOHATA Y, FUJIWARA Y, WATANABE T, et al. Long-term benefits of smoking cessation on gastroesophageal reflux disease and health-related quality of life[J]. PLoS One, 2016, 11(2):e0147860. doi: 10.1371/journal.pone.0147860 URL
[22]	STANCIU C, BENNETT J R. Effects of posture on gastro-oesophageal reflux[J]. Digestion, 1977, 15(2):104-109. doi: 10.1159/000197991 pmid: 14044
[23]	HAMILTON J W, BOISEN R J, YAMAMOTO D T, et al. Sleeping on a wedge diminishes exposure of the esophagus to refluxed acid[J]. Dig Dis Sci, 1988, 33(5):518-522. doi: 10.1007/BF01798350 URL
[24]	PIESMAN M, HWANG I, MAYDONOVITCH C, et al. Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter?[J]. Am J Gastroenterol, 2007, 102(10):2128-2134. doi: 10.1111/j.1572-0241.2007.01348.x pmid: 17573791
[25]	中华医学会消化病学分会胃肠动力学组, 中华医学会消化病学分会胃肠功能性疾病协作组, 中华医学会消化病学分会食管疾病协作组, 等. 中国胃食管反流病诊疗规范[J]. 胃肠病学, 2023, 28(10):597-607.
	Gastrointestinal Motility Group, Functional Gastrointestinal Disease Group, Esophageal Disease Group, Chinese Society of Gastroenterology, Chinese Medical Association, et al. Chinese guidelines for diagnosis and treatment of gastroesophageal reflux disease[J]. Chin J Gastroenter, 2023, 28(10):597-607.
[26]	ZHANG C, KWONG J S, YUAN R X, et al. Effectiveness and tolerability of different recommended doses of PPIs and H(2)RAs in GERD: network meta-analysis and GRADE system[J]. Sci Rep, 2017,7:41021.
[27]	MOAYYEDI P, EIKELBOOM J W, BOSCH J, et al. Safety of proton pump inhibitors based on a large, multi-year, randomized trial of patients receiving rivaroxaban or aspirin[J]. Gastroenterology, 2019, 157(3):682-691.e2. doi: S0016-5085(19)40974-8 pmid: 31152740
[28]	ICHIKAWA H, SUGIMOTO M, SUGIMOTO K, et al. Rapid metabolizer genotype of CYP2C19 is a risk factor of being refractory to proton pump inhibitor therapy for reflux esophagitis[J]. J Gastroenterol Hepatol, 2016, 31(4):716-726. doi: 10.1111/jgh.2016.31.issue-4 URL
[29]	LAINE L, DEVAULT K, KATZ P, et al. Vonoprazan versus lansoprazole for healing and maintenance of healing of erosive esophagitis: a randomized trial[J]. Gastroenterology, 2023, 164(1):61-71. doi: 10.1053/j.gastro.2022.09.041 URL
[30]	SIMADIBRATA D M, SYAM A F, LEE Y Y. A comparison of efficacy and safety of potassium-competitive acid blocker and proton pump inhibitor in gastric acid-related diseases: a systematic review and meta-analysis[J]. J Gastroenterol Hepatol, 2022, 37(12):2217-2228. doi: 10.1111/jgh.v37.12 URL
[31]	HAKANSSON B, MONTGOMERY M, CADIERE G B, et al. Randomised clinical trial: transoral incisionless fundoplication vs. sham intervention to control chronic GERD[J]. Aliment Pharmacol Ther, 2015, 42(11-12):1261-1270. doi: 10.1111/apt.2015.42.issue-11-12 URL
[32]	WITTEMAN B P, CONCHILLO J M, RINSMA N F, et al. Randomized controlled trial of transoral incisionless fundoplication vs. proton pump inhibitors for treatment of gastroesophageal reflux disease[J]. Am J Gastroenterol, 2015, 110(4):531-542. doi: 10.1038/ajg.2015.28 URL
[33]	SNOW G E, DBOUK M, AKST L M, et al. Response of laryngopharyngeal symptoms to transoral incisionless fundoplication in patients with refractory proven gastroesophageal reflux[J]. Ann Otol Rhinol Laryngol, 2022, 131(6):662-670. doi: 10.1177/00034894211037414 URL
[34]	JARUVONGVANICH V K, MATAR R, REISENAUER J, et al. Hiatal hernia repair with transoral incisionless fundoplication versus Nissen fundoplication for gastroesophageal reflux disease: a retrospective study[J]. Endosc Int Open, 2023, 11(1):E11-E18.
[35]	IHDE G M 2nd, PENA C, SCITERN C, et al. pH scores in hiatal repair with transoral incisionless fundoplication[J]. JSLS, 2019, 23(1):e2018.00087.
[36]	CHOI A Y, ROCCATO M K, SAMARASENA J B, et al. Novel interdisciplinary approach to GERD: concomitant laparoscopic hiatal hernia repair with transoral incisionless fundoplication[J]. J Am Coll Surg, 2021, 232(3):309-318. doi: 10.1016/j.jamcollsurg.2020.11.021 URL
[37]	GISI C, WANG K, KHAN F, et al. Efficacy and patient satisfaction of single-session transoral incisionless fundoplication and laparoscopic hernia repair[J]. Surg Endosc, 2021, 35(2):921-927. doi: 10.1007/s00464-020-07796-x
[38]	JANU P, SHUGHOURY A B, VENKAT K, et al. Laparoscopic hiatal hernia repair followed by transoral incisionless fundoplication with EsophyX device (HH + TIF): efficacy and safety in two community hospitals[J]. Surg Innov, 2019, 26(6):675-686. doi: 10.1177/1553350619869449 pmid: 31431138
[39]	FASS R, CAHN F, SCOTTI D J, et al. Systematic review and meta-analysis of controlled and prospective cohort efficacy studies of endoscopic radiofrequency for treatment of gastroesophageal reflux disease[J]. Surg Endosc, 2017, 31(12):4865-4882. doi: 10.1007/s00464-017-5431-2 pmid: 28233093