臨牀消化器内科 Vol.33 No.3(3-1)


特集名 GERD診療2018―現状と課題
題名 GERDの診断(1)自覚症状の評価
発刊年月 2018年 03月
著者 保坂 浩子 群馬大学医学部附属病院消化器・肝臓内科
著者 栗林 志行 群馬大学医学部附属病院消化器・肝臓内科
著者 下山 康之 群馬大学医学部附属病院消化器・肝臓内科
著者 河村 修 群馬大学医学部附属病院光学医療診療部
著者 草野 元康 群馬大学医学部附属病院光学医療診療部
【 要旨 】 胃食道逆流症(gastroesophageal reflux disease ; GERD)は,胃食道逆流により引き起こされる食道粘膜傷害と煩わしい症状のいずれかまたは両者を引き起こす疾患と定義されている.GERDの存在診断における症状の評価は上部消化管内視鏡検査と同様に非常に重要である.GERDの自覚症状には食道症状,食道外症状があり,症状を客観的に評価するためには問診票が有用であるが,本邦ではFスケール(frequency Scale for the Symptoms of GERD)やQUEST(questionnaire for the diagnosis of reflux disease),GERD‒Qが広く使用されている.改訂Fスケールを使用すると,GERDと機能性ディスペプシア(functional dyspepsia ; FD)を同時に評価することが可能である.PPIテストは簡便,低コストで外来診療において施行しやすいGERDの治療的診断法である.
Theme GERD in Clinical Practice 2018 -- Current Status and Issues
Title Diagnosis of GERD -- Evaluation of Symptoms
Author Hiroko Hosaka Department of Gastroenterology and Hepatology, Gunma University Hospital
Author Shiko Kuribayashi Department of Gastroenterology and Hepatology, Gunma University Hospital
Author Yasuyuki Shimoyama Department of Gastroenterology and Hepatology, Gunma University Hospital
Author Osamu Kawamura Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital
Author Motoyasu Kusano Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital
[ Summary ] Gastro‒esophageal reflux disease (GERD) is a condition in which gastroesophageal reflux causes either esophageal mucosal breaks, or troublesome symptoms, or both. It is classified into "erosive GERD" with esophageal mucosal breaks and "non‒erosive GERD or NERD (non‒erosive reflux disease) "wherein patients show symptoms in the absence of esophageal mucosal breaks. Because the diagnosis of this condition is based on assessment of clinical symptoms, the medical interview is essentially the most important component of patient evaluation in clinical practice. In addition to obtaining information regarding the typical/characteristic symptoms of GERD, it is important to inquire regarding extraesophageal symptoms. An overlap between GERD and functional dyspepsia (FD) is known to occur, and these 2 entities are often indistinguishable. Self‒reported questionnaires, such as FSSG (frequency Scale for the Symptoms of GERD, QUEST (questionnaire for the diagnosis of reflux disease) and GERD‒Q, are helpful diagnostic tools in the management of GERD. The modified FSSG could differentiate between GERD and FD by scoring the frequency of both, reflux and dyspeptic symptoms. A response to proton‒pump inhibitors (PPIs) is also commonly considered a supportive aid to diagnose GERD.
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