Modern diagnosis of GERD: the Lyon Consensus.

Abstract:

:Clinical history, questionnaire data and response to antisecretory therapy are insufficient to make a conclusive diagnosis of GERD in isolation, but are of value in determining need for further investigation. Conclusive evidence for reflux on oesophageal testing include advanced grade erosive oesophagitis (LA grades C and D), long-segment Barrett's mucosa or peptic strictures on endoscopy or distal oesophageal acid exposure time (AET) >6% on ambulatory pH or pH-impedance monitoring. A normal endoscopy does not exclude GERD, but provides supportive evidence refuting GERD in conjunction with distal AET <4% and <40 reflux episodes on pH-impedance monitoring off proton pump inhibitors. Reflux-symptom association on ambulatory reflux monitoring provides supportive evidence for reflux triggered symptoms, and may predict a better treatment outcome when present. When endoscopy and pH or pH-impedance monitoring are inconclusive, adjunctive evidence from biopsy findings (histopathology scores, dilated intercellular spaces), motor evaluation (hypotensive lower oesophageal sphincter, hiatus hernia and oesophageal body hypomotility on high-resolution manometry) and novel impedance metrics (baseline impedance, postreflux swallow-induced peristaltic wave index) can add confidence for a GERD diagnosis; however, diagnosis cannot be based on these findings alone. An assessment of anatomy, motor function, reflux burden and symptomatic phenotype will therefore help direct management. Future GERD management strategies should focus on defining individual patient phenotypes based on the level of refluxate exposure, mechanism of reflux, efficacy of clearance, underlying anatomy of the oesophagogastric junction and psychometrics defining symptomatic presentations.

journal_name

Gut

journal_title

Gut

authors

Gyawali CP,Kahrilas PJ,Savarino E,Zerbib F,Mion F,Smout AJPM,Vaezi M,Sifrim D,Fox MR,Vela MF,Tutuian R,Tack J,Bredenoord AJ,Pandolfino J,Roman S

doi

10.1136/gutjnl-2017-314722

subject

Has Abstract

pub_date

2018-07-01 00:00:00

pages

1351-1362

issue

7

eissn

0017-5749

issn

1468-3288

pii

gutjnl-2017-314722

journal_volume

67

pub_type

杂志文章,评审

相关文献

GUT文献大全
  • Molecular footprints reveal the impact of the protective HLA-A*03 allele in hepatitis C virus infection.

    abstract:BACKGROUND AND AIMS:CD8 T cells are central to the control of hepatitis C virus (HCV) although the key features of a successful CD8 T cell response remain to be defined. In a cohort of Irish women infected by a single source, a strong association between viral clearance and the human lecucocyte (HLA)-A*03 allele has be...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.2010.228403

    authors: Fitzmaurice K,Petrovic D,Ramamurthy N,Simmons R,Merani S,Gaudieri S,Sims S,Dempsey E,Freitas E,Lea S,McKiernan S,Norris S,Long A,Kelleher D,Klenerman P

    更新日期:2011-11-01 00:00:00

  • Colonic mass movements in idiopathic chronic constipation.

    abstract::As relatively little is known of human colonic motor activity either in health, or in pathological conditions, we investigated mass movements in 14 chronically constipated patients and 18 healthy volunteers. Mass movements were recorded from proximal and distal colon during 24 h (12 noon-12 noon) by a colonoscopically...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.29.9.1173

    authors: Bassotti G,Gaburri M,Imbimbo BP,Rossi L,Farroni F,Pelli MA,Morelli A

    更新日期:1988-09-01 00:00:00

  • Age-dependent changes in GI physiology and microbiota: time to reconsider?

    abstract::Our life expectancy is increasing, leading to a rise in the ageing population. Ageing is associated with a decline in physiological function and adaptive capacity. Altered GI physiology can affect the amount and types of nutrients digested and absorbed as well as impact the intestinal microbiota. The intestinal microb...

    journal_title:Gut

    pub_type: 杂志文章,评审

    doi:10.1136/gutjnl-2017-315542

    authors: An R,Wilms E,Masclee AAM,Smidt H,Zoetendal EG,Jonkers D

    更新日期:2018-12-01 00:00:00

  • In vivo imaging of colitis and colon cancer development in mice using high resolution chromoendoscopy.

    abstract:BACKGROUND:Mouse models of colitis and cancer are indispensable for our understanding of the pathogenesis of these diseases. In the past, mice had to be sacrificed in order to analyse colitis activity and tumour development. We have developed a safe method for high resolution endoscopic monitoring of living mice. METH...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.2004.061283

    authors: Becker C,Fantini MC,Wirtz S,Nikolaev A,Kiesslich R,Lehr HA,Galle PR,Neurath MF

    更新日期:2005-07-01 00:00:00

  • Combined oro-caecal scintigraphy and lactulose hydrogen breath testing demonstrate that breath testing detects oro-caecal transit, not small intestinal bacterial overgrowth in patients with IBS.

    abstract:OBJECTIVES:Recent studies using the lactulose hydrogen breath test (LHBT) suggest most patients with irritable bowel syndrome (IBS) have small intestinal bacterial overgrowth (SIBO). However, the validity of the LHBT has been questioned, particularly as this test could reflect changes in oro-caecal transit. Therefore, ...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.2009.205476

    authors: Yu D,Cheeseman F,Vanner S

    更新日期:2011-03-01 00:00:00

  • Intraluminal acid induces oesophageal shortening via capsaicin-sensitive neurokinin neurons.

    abstract:OBJECTIVE:Intraluminal acid evokes reflex contraction of oesophageal longitudinal smooth muscle (LSM) and consequent oesophageal shortening. This reflex may play a role in the pathophysiology of oesophageal pain syndromes and hiatus hernia formation. The aim of the current study was to elucidate further the mechanisms ...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.2006.115881

    authors: Paterson WG,Miller DV,Dilworth N,Assini JB,Lourenssen S,Blennerhassett MG

    更新日期:2007-10-01 00:00:00

  • Coronary artery disease and cardiovascular outcomes in patients with non-alcoholic fatty liver disease.

    abstract:OBJECTIVE:Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome and is associated with cardiovascular risk. The aim of this study was to determine the role of fatty liver in predicting coronary artery disease and clinical outcomes in patients undergoing coronary angiogram. METHOD...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.2011.242016

    authors: Wong VW,Wong GL,Yip GW,Lo AO,Limquiaco J,Chu WC,Chim AM,Yu CM,Yu J,Chan FK,Sung JJ,Chan HL

    更新日期:2011-12-01 00:00:00

  • Bacterial adhesion and disease activity in Helicobacter associated chronic gastritis.

    abstract::Ultrastructural examination of biopsies showing Helicobacter pylori associated chronic gastritis reveals close attachment between gastric surface epithelial cells and the organism. The finding of 'adhesion pedestals', which represents a cellular response to the presence of the organism, is analogous to the response of...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.31.2.134

    authors: Hessey SJ,Spencer J,Wyatt JI,Sobala G,Rathbone BJ,Axon AT,Dixon MF

    更新日期:1990-02-01 00:00:00

  • Intramucosal adenocarcinoma arising under squamous re-epithelialisation of Barrett's oesophagus.

    abstract:BACKGROUND:Eradication of Barrett's mucosa by thermal or photoablation combined with high doses of proton pump inhibitors is a potentially attractive strategy in the management of this preneoplastic condition. However, major concerns of this method are the persistence of residual metaplastic glands beneath the new squa...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.46.4.574

    authors: Van Laethem JL,Peny MO,Salmon I,Cremer M,Devière J

    更新日期:2000-04-01 00:00:00

  • Helicobacter pylori potentiates epithelial:mesenchymal transition in gastric cancer: links to soluble HB-EGF, gastrin and matrix metalloproteinase-7.

    abstract:BACKGROUND AND AIMS:Helicobacter pylori (H pylori) infection is a major risk factor in the development of distal gastric adenocarcinoma. Development of the invasive phenotype is associated with the phenomenon of epithelial:mesenchymal transition (EMT). Soluble heparin-binding epidermal growth factor (HB-EGF) has been i...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.2009.199794

    authors: Yin Y,Grabowska AM,Clarke PA,Whelband E,Robinson K,Argent RH,Tobias A,Kumari R,Atherton JC,Watson SA

    更新日期:2010-08-01 00:00:00

  • Acid and gastrin responses during intragastric titration in normal subjects and duodenal ulcer patients with G-cell hyperfunction.

    abstract::Amino acid induced acid and gastrin responses during intragastric titration at pH 2.5 and 5.5 were compared in normal subjects and duodenal ulcer patients with G-cell hyperfunction. The latter were identified on the basis of raised basal or maximal acid outputs and increased gastrin responses to feeding. In normal sub...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.26.3.232

    authors: Cooper RG,Dockray GJ,Calam J,Walker R

    更新日期:1985-03-01 00:00:00

  • Reduction of gastrointestinal protein loss by elemental diet in Crohn's disease of the small bowel.

    abstract::Seven patients with hypoalbuminaemia and extensive jejunoileal Crohn's disease were treated with an elemental diet for 28 to 56 days. Over this time there was an increase in total plasma proteins from mean of 49.1 to 59.0 g/l and a mean rise in serum albumin from 20.7 to 30.0 g/l (P less than 0.05). In addition, there...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.22.5.383

    authors: Logan RF,Gillon J,Ferrington C,Ferguson A

    更新日期:1981-05-01 00:00:00

  • Motor activity recorded in the unprepared colon of healthy humans.

    abstract::A manometric method was developed to study the motor activity in the unprepared human colon, and the results in eight healthy subjects were compared with those obtained in the same subjects after bowel cleansing with a non-absorbable solution containing polyethylene glycol 4000 (PEG). A tube assembly (4.5 m long, 12 l...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.37.5.649

    authors: Lémann M,Flourié B,Picon L,Coffin B,Jian R,Rambaud JC

    更新日期:1995-11-01 00:00:00

  • Fat transforms ascorbic acid from inhibiting to promoting acid-catalysed N-nitrosation.

    abstract:BACKGROUND:The major potential site of acid nitrosation is the proximal stomach, an anatomical site prone to a rising incidence of metaplasia and adenocarcinoma. Nitrite, a pre-carcinogen present in saliva, can be converted to nitrosating species and N-nitroso compounds by acidification at low gastric pH in the presenc...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.2007.128587

    authors: Combet E,Paterson S,Iijima K,Winter J,Mullen W,Crozier A,Preston T,McColl KE

    更新日期:2007-12-01 00:00:00

  • Effect of phospholipids and their molecular species on cholesterol solubility and nucleation in human and model biles.

    abstract::Much research in the pathophysiology of gall stones has been devoted to various molecular species of bile salts. Recent findings have shown the importance of phospholipids in biliary pathophysiology. In the present study the addition of increasing doses of egg lecithin to human and model biles progressively prolonged ...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.34.1.110

    authors: Halpern Z,Moshkowitz M,Laufer H,Peled Y,Gilat T

    更新日期:1993-01-01 00:00:00

  • MicroRNA-29c mediates initiation of gastric carcinogenesis by directly targeting ITGB1.

    abstract:OBJECTIVE:Gastric cancer (GC) remains difficult to cure due to heterogeneity in a clinical challenge and the molecular mechanisms underlying this disease are complex and not completely understood. Accumulating evidence suggests that microRNAs (miRNAs) play an important role in GC, but the role of specific miRNAs involv...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gutjnl-2013-306640

    authors: Han TS,Hur K,Xu G,Choi B,Okugawa Y,Toiyama Y,Oshima H,Oshima M,Lee HJ,Kim VN,Chang AN,Goel A,Yang HK

    更新日期:2015-02-01 00:00:00

  • British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines.

    abstract::These consensus guidelines were jointly commissioned by the British Society of Gastroenterology (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and Public Health England (PHE). They provide an evidence-based framework for the use of surveillance colonoscopy and non-colonoscopic colorecta...

    journal_title:Gut

    pub_type: 杂志文章,实务指引

    doi:10.1136/gutjnl-2019-319858

    authors: Rutter MD,East J,Rees CJ,Cripps N,Docherty J,Dolwani S,Kaye PV,Monahan KJ,Novelli MR,Plumb A,Saunders BP,Thomas-Gibson S,Tolan DJM,Whyte S,Bonnington S,Scope A,Wong R,Hibbert B,Marsh J,Moores B,Cross A,Sharp L

    更新日期:2020-02-01 00:00:00

  • An investigation into the enzyme histochemistry of adenocarcinomas of human large intestine and of the transitional epithelium immediately adjacent to them.

    abstract::Histochemical enzymatic studies were performed on 30 freshly resected large bowel carcinomas, 30 samples of normal colonic epithelium, and six samples of the histologically normal epithelium (so-called transitional epithelium) immediately adjacent to a carcinoma. Five enzymes were studied: nicotine adenine dinucleotid...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.15.10.783

    authors: Marsden JR,Dawson IM

    更新日期:1974-10-01 00:00:00

  • Value of a centralised approach in the management of haematemesis and melaena: experience in a district general hospital.

    abstract::All patients presenting with acute upper gastrointestinal bleeding between November 1986 and April 1988 were admitted to a centralised joint medical/surgical unit, with a policy of early clinical and endoscopic assessment and rapid surgical intervention in those at high risk. Of the 430 patients admitted 69.5% were ov...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.31.5.504

    authors: Holman RA,Davis M,Gough KR,Gartell P,Britton DC,Smith RB

    更新日期:1990-05-01 00:00:00

  • Pentagastrin induced motility pattern in the human upper gastrointestinal tract is reversed by proglumide.

    abstract::The effects of pentagastrin and the putative gastrin antagonist proglumide on interdigestive motility of the upper small bowel were studied in a randomised double blind study in 10 healthy human volunteers. Intraluminal pressures were recorded manometrically in the duodenum and jejunum for five hours. Sixty minutes af...

    journal_title:Gut

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1136/gut.25.9.953

    authors: Erckenbrecht JF,Caspari J,Wienbeck M

    更新日期:1984-09-01 00:00:00

  • Plasminogen fragment K1-5 improves survival in a murine hepatocellular carcinoma model.

    abstract:BACKGROUND:The prognosis of patients with hepatocellular carcinoma (HCC) remains poor, and new alternative treatments are needed. AIMS:To comparatively test the angiostatic and antitumour effects of adenoviral gene transfer of angiostatin (PlgK1-4, amino acids 1-440) and full kringles 1-5 (PlgK1-5, amino acids 1-546) ...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.2005.088583

    authors: Schmitz V,Raskopf E,Gonzalez-Carmona MA,Vogt A,Rabe C,Leifeld L,Kornek M,Sauerbruch T,Caselmann WH

    更新日期:2007-02-01 00:00:00

  • Evaluation of indium scintigraphy in patients with active inflammatory bowel disease.

    abstract::Recent reports have indicated a possible role for 111Indium leucocyte scintigraphy in the management of patients with acute inflammatory bowel disease. Our experience with this technique in 15 patients (nine with ulcerative colitis, six with Crohn's disease) is described. Perfect agreement was not obtained between sci...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.25.12.1372

    authors: Buxton-Thomas MS,Dickinson RJ,Maltby P,Hunter JO,Wraight EP

    更新日期:1984-12-01 00:00:00

  • The effect of phenobarbital on cholesterol gallstones in hamsters.

    abstract::This experimental study was undertaken to follow the influence of phenobarbital on bile chemistry and gallstone formation. Phenobarbital (400 mg/kg/day) was administered to golden hamsters receiving a diet known to induce cholesterol gallstones. After a 28-day period none of the control animals had gallstones whereas ...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.14.12.956

    authors: Lagarriga J,Bouchier IA

    更新日期:1973-12-01 00:00:00

  • Chronic intrahepatic cholestasis due to sarcoidosis.

    abstract::Two West Indian patients with Kveim-biopsy proven sarcoidosis developed chronic cholestatic liver disease, clinically and biochemically similar to primary biliary cirrhosis. Liver histology revealed multiple granulomas with reduction in bile ducts and, in one patient, progression to biliary cirrhosis. Portal hypertens...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.23.5.417

    authors: Bass NM,Burroughs AK,Scheuer PJ,James DG,Sherlock S

    更新日期:1982-05-01 00:00:00

  • Response to autoimmune enteropathy to cyclosporin A therapy.

    abstract::Small bowel enteropathies that are associated with an autoimmune process are often resistant to treatment. Two children with autoimmune enteropathy were treated with cyclosporin A for eight months. Both improved, as assessed by growth, small intestinal mucosal morphology, and carbohydrate absorption. Cyclosporin A is ...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.32.11.1421

    authors: Sanderson IR,Phillips AD,Spencer J,Walker-Smith JA

    更新日期:1991-11-01 00:00:00

  • Value of hypotonic duodenography as an adjunct to pancreatic scanning.

    abstract::A technique has been developed which allows the position of the upper gastrointestinal tract, as determined radiographically, to be superimposed on the pancreatic photoscan, performed after an injection of (75)Se-selenomethionine. Results of the technique applied to 27 ;abnormal' and 23 ;normal' subjects are described...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.10.8.665

    authors: McCarthy DM,Kreel L,Agnew JE,Bouchier IA

    更新日期:1969-08-01 00:00:00

  • Absent ileal uptake of IF-bound vitamin B12 in vivo in the Imerslund-Grasbeck syndrome (familial vitamin B12 malabsorption with proteinuria).

    abstract::A Syrian family is described with three children who had inherited selective vitamin B12 malabsorption associated with proteinuria. (Imerslund-Grasbeck syndrome). Although inherited the defect was apparently not present at birth. A third child had less severe vitamin B12 malabsorption, was not vitamin B12 deficient an...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.26.3.311

    authors: Burman JF,Jenkins WJ,Walker-Smith JA,Phillips AD,Sourial NA,Williams CB,Mollin DL

    更新日期:1985-03-01 00:00:00

  • Adrenergic effects on exocrine secretion of rat submandibular epidermal growth factor.

    abstract::The present study was undertaken to investigate the effect of alpha- and beta-adrenergic agonists on secretion of epidermal growth factor (EGF) from the rat submandibular glands and to test the possibility of intestinal absorption of EGF. Alpha-adrenergic agonists increased the concentration of salivary EGF by approxi...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.25.11.1234

    authors: Olsen PS,Kirkegaard P,Poulsen SS,Nexø E

    更新日期:1984-11-01 00:00:00

  • Intestinal metaplasia at the gastro-oesophageal junction: Helicobacter pylori gastritis or gastro-oesophageal reflux disease?

    abstract:BACKGROUND:Intestinal metaplasia, whether in the cardia or the distal oesophagus, has been uniformly defined as specialised columnar epithelium, suggesting a relation with Barrett's oesophagus. It is, however, not clear whether the risk factors associated with intestinal metaplasia are identical at both sites. AIMS:To...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.43.1.17

    authors: Hackelsberger A,Günther T,Schultze V,Manes G,Dominguez-Muñoz JE,Roessner A,Malfertheiner P

    更新日期:1998-07-01 00:00:00

  • Renal function in fulminant hepatic failure: haemodynamics and renal prostaglandins.

    abstract::Eighteen patients with fulminant liver failure were studied, 10 with normal renal function (group A) and eight with renal failure (group B, plasma creatinine greater than 200 mumol/l). Renal function was assessed by standard clearance techniques and patients in group B had a marked reduction compared with group A in b...

    journal_title:Gut

    pub_type: 杂志文章

    doi:10.1136/gut.28.12.1643

    authors: Guarner F,Hughes RD,Gimson AE,Williams R

    更新日期:1987-12-01 00:00:00