medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-7-16-26medsovet-6855Research ArticleЗаболевания пищевода и желудкаDiseases of the esophagus and stomachГастроэзофагеальная рефлюксная болезнь: факторы риска, современные возможности диагностики и оптимизации леченияGastroesophageal reflux disease: risk factors, current possibilities of diagnosis and treatment optimisationhttps://orcid.org/0000-0001-6114-564XМаевИ. В.MaevI. V.

Маев Игорь Вениаминович - академик РАН, доктор медицинских наук, профессор, заслуженный врач РФ, заслуженный деятель науки РФ, заведующий кафедрой пропедевтики внутренних болезней и гастроэнтерологии.

127473, Москва, ул. Делегатская, д. 20, стр. 1.

Igor V. Maev - Academician of the RAS, Dr. Sci. (Med.), Professor, Honoured Physician of the Russian Federation, Honoured Scientist of the Russian Federation, Head of the Department of Internal Medicine and Gastroenterology, Yevdokimov Moscow State University of Medicine and Dentistry.

20, Bldg. 1, Delegatskaya St., Moscow, 127473.

igormaev@rambler.ruhttps://orcid.org/0000-0002-4007-7112АндреевД. Н.AndreevD. N.

Андреев Дмитрий Николаевич - кандидат медицинских наук, доцент кафедры пропедевтики внутренних болезней и гастроэнтерологии, научный сотрудник лаборатории функциональных методов исследования в гастроэнтерологии.

127473, Москва, ул. Делегатская, д. 20, стр. 1.

Dmitry N. Andreev - Cand. Sci. (Med.), Associate Professor, Associate Professor of the Department of Propaedeutics of Internal Diseases and Gastroenterology, Yevdokimov Moscow State University of Medicine and Dentistry.

20, Bldg. 1, Delegatskaya St., Moscow, 127473.

dna-mit8@mail.ruhttps://orcid.org/0000-0003-4511-6704ОвсепянМ. А.OvsepyanM. A.

Овсепян Мария Александровна - ассистент кафедры пропедевтики внутренних болезней и гастроэнтерологии, научный сотрудник лаборатории функциональных методов исследования в гастроэнтерологии.

127473, Москва, ул. Делегатская, д. 20, стр. 1.

Mariya A. Ovsepyan - Assistant Professor of the Department of Internal Medicine and Gastroenterology, Researcher of the Laboratory of Functional Research Methods in Gastroenterology, Yevdokimov Moscow State University of Medicine and Dentistry.

20, Bldg. 1, Delegatskaya St., Moscow, 127473.

solnwshko_@mail.ruhttps://orcid.org/0000-0001-5882-9397БаркаловаЕ. В.BarkalovaE. V.

Баркалова Елена Вячеславовна - ассистент кафедры пропедевтики внутренних болезней и гастроэнтерологии, руководитель лаборатории функциональных методов исследования в гастроэнтерологии.

127473, Москва, ул. Делегатская, д. 20, стр. 1.

Elena V. Barkalova - Assistant Professor of the Department of Internal Medicine and Gastroenterology, Researcher of the Laboratory of Functional Research Methods in Gastroenterology, Yevdokimov Moscow State University of Medicine and Dentistry.

20, Bldg. 1, Delegatskaya St., Moscow, 127473.

maslovaalena@mail.ruМосковский государственный медико-стоматологический университет имени А.И. ЕвдокимоваРоссияYevdokimov Moscow State University of Medicine and DentistryRussian Federation202213052022071626Copyright © Маев И.В., Андреев Д.Н., Овсепян М.А., Баркалова Е.В., 20222022Маев И.В., Андреев Д.Н., Овсепян М.А., Баркалова Е.В.Maev I.V., Andreev D.N., Ovsepyan M.A., Barkalova E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6855

Гастроэзофагеальная рефлюксная болезнь (ГЭРБ) является одной из самых распространенных причин обращения за медицинской помощью на уровне первичного звена здравоохранения во многих странах. На эпидемиологическом уровне показано, что ГЭРБ ассоциирована с целым рядом факторов риска: ожирение, табакокурение, злоупотребление алкоголем, определенные паттерны пищевого поведения, прием ряда лекарственных препаратов. В настоящее время ГЭРБ рассматривается как гетерогенное заболевание и включает в себя различные фенотипы (эрозивная рефлюксная болезнь, неэрозивная рефлюксная болезнь, гиперсенситивный пищевод, функциональная изжога), правильная диагностика которых способствует повышению эффективности терапии пациентов с симптомом изжоги. Известно, что суточная рН-импедансометрия является неотъемлемой частью диагностического алгоритма при ГЭРБ и представляет собой метод функциональной диагностики, который позволяет  регистрировать  все  виды  рефлюксов, попадающих  в  пищевод  независимо  от  рН,  а также оценивать их связь с симптомами и определять принадлежность пациентов с симптомом изжоги к тому или иному фенотипу. Манометрия пищевода играет ключевую роль в оценке пациентов с симптомом изжоги, поскольку помогает исключить другие состояния, которые могут имитировать ГЭРБ: ахалазия кардии и склеродермия пищевода. Данная методика  используется  для  оценки  нарушений  моторики  грудного  отдела  пищевода,  работы  его  сфинктерного  аппарата,   а также при оценке пациентов перед антирефлюксными операциями или при рефрактерном течении ГЭРБ. В статье подробно описаны факторы риска ГЭРБ (триггеры изжоги), а также аспекты диагностики с учетом дифференцированного подхода к пациентам с изжогой на основании данных суточной рН-импедансометрии в соответствии с современными согласительными документами и рекомендациями.

Gastroesophageal reflux disease (GERD) is one of the most common causes of health care seeking at the primary care level in many countries. At an epidemiological level, GERD has been shown to be associated with a number of risk factors: obesity, tobacco smoking, alcohol abuse, certain patterns of eating behaviour, and the use of several medications. GERD is now regarded as a heterogeneous disease and includes different phenotypes (erosive reflux disease, non-erosive reflux disease, hypersensitive oesophagus, functional heartburn), the proper diagnosis of which improves the effectiveness of therapy in patients with heartburn symptoms. Daily impedance–pH monitoring is known to be an integral part of the diagnostic algorithm for GERD and is a functional diagnostic method to record all types of refluxes entering the oesophagus regardless of pH, to assess their association with symptoms, and to determine whether patients with heartburn symptoms belong to a particular phenotype. Esophageal manometry plays a key role in the evaluation of patients with heartburn symptoms, as it helps to rule out other conditions that may mimic GERD: achalasia cardia and scleroderma esophagus. This technique is used to assess thoracic esophageal motility and sphincter function and in the assessment of patients prior to antireflux surgery or in the refractory course of GERD. The article describes in detail GERD risk factors (triggers of heartburn), as well as diagnostic aspects, taking into account a differentiated approach to patients with heartburn based on daily impedance–pH monitoring data in accordance with the current guidelines and recommendations.

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The authors declare that there are no conflicts of interest present.