Gastroesophageal reflux disease (GERD) is characterized by significant clinical heterogeneity. Conventional diagnostic approaches, including symptom-based questionnaires, empirical acid suppression trials, and single-modality objective tests, demonstrate limited sensitivity and specificity, often resulting in diagnostic inaccuracies and inefficient resource utilization. To overcome these diagnostic challenges, this article provides a systematic review of recent advancements and ongoing debates in GERD diagnostics, with a focus on the diagnostic value of multimodal parameters as outlined in the Lyon Consensus 2.0. It also explores the clinical relevance of emerging auxiliary diagnostic metrics. We emphasize that integrating clinical symptomatology, endoscopic findings, esophageal physiological measurements, and psychosocial factors (augmented by composite scoring systems and artificial intelligence), offers a promising strategy for accurate diagnosis and personalized treatment of GERD.

Objective:This study aims to conduct a systematic review and network meta-analysis comparing the safety and efficacy of endoscopic versus surgical treatments for gastroesophageal reflux disease (GERD).Methods:Randomized controlled trials were identified through systematic searches of MEDLINE, Embase, Web of Science, and CNKI. Both direct effect models and Bayesian random-effects network meta-analysis were used to compare treatments directly and indirectly. The following types of studies were included : (1) RCTs involving endoscopic or surgical treatment for adult GERD patients aged ≥18 years with no previous history of gastroesophageal surgery; (2) studies comparing two or more treatment methods, including different endoscopic or surgical procedures, proton pump inhibitor (PPI) therapy, and/or sham surgery; and (3) articles published in Chinese or English. Review articles and conference abstracts were excluded.Results:A total of 47 randomized controlled trials were enrolled, and 43 studies were network meta-analyzed. Both endoscopic and surgical treatments significantly reduced postoperative PPI use compared to PPI therapy ( P <0.05). Among all treatment modalities, laparoscopic Nissen fundoplication (LNF, SUCRA=0.84) demonstrated the highest efficacy, followed by laparoscopic Toupet fundoplication (LTF, SUCRA=0.71) and anterior partial fundoplication (APF, SUCRA=0.70). Transoral incisionless fundoplication (TIF) demonstrated the best outcomes in relieving heartburn (SUCRA=0.87) and bloating (SUCRA=0.86) symptoms. The overall safety of surgical treatment was comparable to that of PPI therapy. However, LNF was associated with a higher incidence of postoperative dysphagia and gas-related symptoms, whereas TIF had a lower risk of postoperative complications. Conclusions:Both endoscopic and surgical treatments are effective for GERD. LNF provides the highest rate of medication discontinuation but carries a higher risk of postoperative complications. TIF offers better relief of heartburn and bloating with fewer complications.

Background/Aims: Reflux symptoms frequently present in patients diagnosed with functional dyspepsia (FD). This investigation sought to elucidate the contribution of gastroesophageal reflux in the overlap relationship. Methods: Consecutive patients presenting with reflux symptoms and/or FD symptoms were prospectively included. Comprehensive assessments, including symptoms evaluation, endoscopy, esophageal functional examinations (high-resolution manometry and reflux monitoring), and proton pump inhibitor (PPI) treatment efficacy evaluation, were conducted in these patients. Results: The study enrolled 315 patients, 43.2% of which had concurrent FD symptoms and overlapping reflux symptoms. Notably, a mere 28.7% of patients in the overlap symptoms group had objective gastroesophageal reflux disease evidences (the grade of esophagitis≥ B or the acid exposure time ≥ 4.2%). Functional heartburn was demonstrated to be the main cause of overlapping reflux symptoms(55.1%). Reflux parameters analysis revealed that the reflux burden in the overlap symptoms group paralleled that of the FD symptoms group, with both registering lower levels than the reflux symptoms group (P < 0.05). Furthermore, PPI response rates were notably diminished in the overlap symptoms group (P < 0.001), even for those with objective gastroesophageal reflux disease evidences. Conclusions The study illuminated that overlapping reflux symptoms in FD was common. Strikingly, these symptoms primarily diverged from reflux etiology and exhibited suboptimal responses to PPI intervention. These findings challenge prevailing paradigms and accentuate the imperative for nuanced therapeutic approaches tailored to the distinctive characteristics of overlapping reflux symptoms in the context of FD.

Background/Aims: Reflux symptoms frequently present in patients diagnosed with functional dyspepsia (FD). This investigation sought to elucidate the contribution of gastroesophageal reflux in the overlap relationship. Methods: Consecutive patients presenting with reflux symptoms and/or FD symptoms were prospectively included. Comprehensive assessments, including symptoms evaluation, endoscopy, esophageal functional examinations (high-resolution manometry and reflux monitoring), and proton pump inhibitor (PPI) treatment efficacy evaluation, were conducted in these patients. Results: The study enrolled 315 patients, 43.2% of which had concurrent FD symptoms and overlapping reflux symptoms. Notably, a mere 28.7% of patients in the overlap symptoms group had objective gastroesophageal reflux disease evidences (the grade of esophagitis≥ B or the acid exposure time ≥ 4.2%). Functional heartburn was demonstrated to be the main cause of overlapping reflux symptoms(55.1%). Reflux parameters analysis revealed that the reflux burden in the overlap symptoms group paralleled that of the FD symptoms group, with both registering lower levels than the reflux symptoms group (P < 0.05). Furthermore, PPI response rates were notably diminished in the overlap symptoms group (P < 0.001), even for those with objective gastroesophageal reflux disease evidences. Conclusions The study illuminated that overlapping reflux symptoms in FD was common. Strikingly, these symptoms primarily diverged from reflux etiology and exhibited suboptimal responses to PPI intervention. These findings challenge prevailing paradigms and accentuate the imperative for nuanced therapeutic approaches tailored to the distinctive characteristics of overlapping reflux symptoms in the context of FD.

Background/Aims: Reflux symptoms frequently present in patients diagnosed with functional dyspepsia (FD). This investigation sought to elucidate the contribution of gastroesophageal reflux in the overlap relationship. Methods: Consecutive patients presenting with reflux symptoms and/or FD symptoms were prospectively included. Comprehensive assessments, including symptoms evaluation, endoscopy, esophageal functional examinations (high-resolution manometry and reflux monitoring), and proton pump inhibitor (PPI) treatment efficacy evaluation, were conducted in these patients. Results: The study enrolled 315 patients, 43.2% of which had concurrent FD symptoms and overlapping reflux symptoms. Notably, a mere 28.7% of patients in the overlap symptoms group had objective gastroesophageal reflux disease evidences (the grade of esophagitis≥ B or the acid exposure time ≥ 4.2%). Functional heartburn was demonstrated to be the main cause of overlapping reflux symptoms(55.1%). Reflux parameters analysis revealed that the reflux burden in the overlap symptoms group paralleled that of the FD symptoms group, with both registering lower levels than the reflux symptoms group (P < 0.05). Furthermore, PPI response rates were notably diminished in the overlap symptoms group (P < 0.001), even for those with objective gastroesophageal reflux disease evidences. Conclusions The study illuminated that overlapping reflux symptoms in FD was common. Strikingly, these symptoms primarily diverged from reflux etiology and exhibited suboptimal responses to PPI intervention. These findings challenge prevailing paradigms and accentuate the imperative for nuanced therapeutic approaches tailored to the distinctive characteristics of overlapping reflux symptoms in the context of FD.

Objective:This study aims to conduct a systematic review and network meta-analysis comparing the safety and efficacy of endoscopic versus surgical treatments for gastroesophageal reflux disease (GERD).Methods:Randomized controlled trials were identified through systematic searches of MEDLINE, Embase, Web of Science, and CNKI. Both direct effect models and Bayesian random-effects network meta-analysis were used to compare treatments directly and indirectly. The following types of studies were included : (1) RCTs involving endoscopic or surgical treatment for adult GERD patients aged ≥18 years with no previous history of gastroesophageal surgery; (2) studies comparing two or more treatment methods, including different endoscopic or surgical procedures, proton pump inhibitor (PPI) therapy, and/or sham surgery; and (3) articles published in Chinese or English. Review articles and conference abstracts were excluded.Results:A total of 47 randomized controlled trials were enrolled, and 43 studies were network meta-analyzed. Both endoscopic and surgical treatments significantly reduced postoperative PPI use compared to PPI therapy ( P <0.05). Among all treatment modalities, laparoscopic Nissen fundoplication (LNF, SUCRA=0.84) demonstrated the highest efficacy, followed by laparoscopic Toupet fundoplication (LTF, SUCRA=0.71) and anterior partial fundoplication (APF, SUCRA=0.70). Transoral incisionless fundoplication (TIF) demonstrated the best outcomes in relieving heartburn (SUCRA=0.87) and bloating (SUCRA=0.86) symptoms. The overall safety of surgical treatment was comparable to that of PPI therapy. However, LNF was associated with a higher incidence of postoperative dysphagia and gas-related symptoms, whereas TIF had a lower risk of postoperative complications. Conclusions:Both endoscopic and surgical treatments are effective for GERD. LNF provides the highest rate of medication discontinuation but carries a higher risk of postoperative complications. TIF offers better relief of heartburn and bloating with fewer complications.

Objective:To investigate the current level of awareness among Chinese gastroenterologists regarding small intestinal bacterial overgrowth (SIBO).Methods:From March 7th to April 14th, 2024, an online survey questionnaire was sent to qualified clinical physicians specializing in gastroenterology in various levels of general hospitals across the country through the official channels of national academic organizations such as the Gastroenterology Branch of the Chinese Medical Association, the Gastrointestinal Motility Group of the Gastroenterology Branch of the Chinese Medical Association, and the Functional Gastrointestinal Disorders Collaborative Group of the Gastroenterology Branch of the Chinese Medical Association, as well as through the national medical continuing education project cooperation platform. The questionnaire content includes basic information, awareness of consensus guidelines on functional gastrointestinal disorders (FGID) and SIBO, understanding of SIBO and its diagnosis and treatment strategies, et al. The influencing factors of physicians′ cognitive level regarding SIBO were analyzed based on the questionnaire results. Statistical methods employed descriptive statistical method and partial correlation analysis.Results:A total of 511 valid questionnaires were collected, among them, 78.1% (399/511) of the respondents practiced in tertiary hospitals, and 90.2% (461/511) of the respondents were aware of the definition of SIBO. However, only 9.0% (46/511) could accurately identify all the key points of the relevant consensus guidelines. Educational background (undergraduate and master′s degree vs. doctor degree, OR=0.265, 0.528, 95% confidence interval(95% CI): 0.155 to 0.454, 0.322 to 0.865), professional title (junior title vs. senior title, OR=0.577, 95% CI: 0.344 to 0.968), and the number of SIBO cases handled per year (less than 50 cases vs. more than 200 cases, OR=0.144, 95% CI: 0.043 to 0.479) were independent influencing factors that affect the cognitive level of specialist physicians regarding SIBO and the guidelines (all P<0.05). The results of hydrogen and methane breath test (HMBT) was the main reference indicator for diagnosing SIBO in the respondents (79.8%, 408/511), but only 8.4%(43/511) of the specialists were familiar with the principle of HMBT, and 65.9% (337/511) were not clear about the differences in diagnostic thresholds among different consensus or guidelines. Rifaximin was the most commonly used therapy (87.5%, 447/511), but there was significant heterogeneity in the selection of dosage and treatment course. According to the survey, 17.6% (90/511) of the clinicians believed that comprehensive assessment of the patient′s clinical condition was not necessary for the diagnosis and treatment of FGID. Conclusion:Gastroenterologists are familiar with the basic concepts of SIBO, but their understanding of the diagnostic criteria application and the latest research progress is limited.

Gastroesophageal reflux disease (GERD) is characterized by significant clinical heterogeneity. Conventional diagnostic approaches, including symptom-based questionnaires, empirical acid suppression trials, and single-modality objective tests, demonstrate limited sensitivity and specificity, often resulting in diagnostic inaccuracies and inefficient resource utilization. To overcome these diagnostic challenges, this article provides a systematic review of recent advancements and ongoing debates in GERD diagnostics, with a focus on the diagnostic value of multimodal parameters as outlined in the Lyon Consensus 2.0. It also explores the clinical relevance of emerging auxiliary diagnostic metrics. We emphasize that integrating clinical symptomatology, endoscopic findings, esophageal physiological measurements, and psychosocial factors (augmented by composite scoring systems and artificial intelligence), offers a promising strategy for accurate diagnosis and personalized treatment of GERD.

Objective:To investigate the current level of awareness among Chinese gastroenterologists regarding small intestinal bacterial overgrowth (SIBO).Methods:From March 7th to April 14th, 2024, an online survey questionnaire was sent to qualified clinical physicians specializing in gastroenterology in various levels of general hospitals across the country through the official channels of national academic organizations such as the Gastroenterology Branch of the Chinese Medical Association, the Gastrointestinal Motility Group of the Gastroenterology Branch of the Chinese Medical Association, and the Functional Gastrointestinal Disorders Collaborative Group of the Gastroenterology Branch of the Chinese Medical Association, as well as through the national medical continuing education project cooperation platform. The questionnaire content includes basic information, awareness of consensus guidelines on functional gastrointestinal disorders (FGID) and SIBO, understanding of SIBO and its diagnosis and treatment strategies, et al. The influencing factors of physicians′ cognitive level regarding SIBO were analyzed based on the questionnaire results. Statistical methods employed descriptive statistical method and partial correlation analysis.Results:A total of 511 valid questionnaires were collected, among them, 78.1% (399/511) of the respondents practiced in tertiary hospitals, and 90.2% (461/511) of the respondents were aware of the definition of SIBO. However, only 9.0% (46/511) could accurately identify all the key points of the relevant consensus guidelines. Educational background (undergraduate and master′s degree vs. doctor degree, OR=0.265, 0.528, 95% confidence interval(95% CI): 0.155 to 0.454, 0.322 to 0.865), professional title (junior title vs. senior title, OR=0.577, 95% CI: 0.344 to 0.968), and the number of SIBO cases handled per year (less than 50 cases vs. more than 200 cases, OR=0.144, 95% CI: 0.043 to 0.479) were independent influencing factors that affect the cognitive level of specialist physicians regarding SIBO and the guidelines (all P<0.05). The results of hydrogen and methane breath test (HMBT) was the main reference indicator for diagnosing SIBO in the respondents (79.8%, 408/511), but only 8.4%(43/511) of the specialists were familiar with the principle of HMBT, and 65.9% (337/511) were not clear about the differences in diagnostic thresholds among different consensus or guidelines. Rifaximin was the most commonly used therapy (87.5%, 447/511), but there was significant heterogeneity in the selection of dosage and treatment course. According to the survey, 17.6% (90/511) of the clinicians believed that comprehensive assessment of the patient′s clinical condition was not necessary for the diagnosis and treatment of FGID. Conclusion:Gastroenterologists are familiar with the basic concepts of SIBO, but their understanding of the diagnostic criteria application and the latest research progress is limited.

Background::Erosive esophagitis (EE) is a gastroesophageal reflux disease characterized by mucosal breaks in the esophagus. Proton pump inhibitors are widely used as maintenance therapy for EE, but many patients still relapse. In this trial, we evaluated the noninferiority of vonoprazan vs. lansoprazole as maintenance therapy in patients with healed EE. Methods::We performed a double-blind, double-dummy, multicenter, phase 3 clinical trial among non-Japanese Asian adults with endoscopically confirmed healed EE from April 2015 to February 2019. Patients from China, South Korea, and Malaysia were randomized to vonoprazan 10 mg or 20 mg once daily or lansoprazole 15 mg once daily for 24 weeks. The primary endpoint was endoscopically confirmed EE recurrence rate over 24 weeks with a noninferiority margin of 10% using a two-sided 95% confidence interval (CI). Treatment-emergent adverse events (TEAEs) were recorded.Results::Among 703 patients, EE recurrence was observed in 24/181 (13.3%) and 21/171 (12.3%) patients receiving vonoprazan 10 mg or 20 mg, respectively, and 47/184 (25.5%) patients receiving lansoprazole (differences: -12.3% [95% CI, -20.3% to-4.3%] and -13.3% [95% CI, -21.3% to -5.3%], respectively), meeting the primary endpoint of noninferiority to lansoprazole in preventing EE recurrence at 24 weeks. Evidence of superiority (upper bound of 95% CI <0%) was also observed. At 12 weeks, endoscopically confirmed EE recurrence was observed in 5/18, 2/20, and 7/20 of patients receiving vonoprazan 10 mg, vonoprazan 20 mg, and lansoprazole, respectively. TEAEs were experienced by 66.8% (157/235), 69.0% (156/226), and 65.3% (158/242) of patients receiving vonoprazan 10 mg, vonoprazan 20 mg, and lansoprazole, respectively. The most common TEAE was upper respiratory tract infection in 12.8% (30/235) and 12.8% (29/226) patients in vonoprazan 10 mg and 20 mg groups, respectively and 8.7% (21/242) patients in lansoprazole group.Conclusion::Vonoprazan maintenance therapy was well-tolerated and noninferior to lansoprazole for preventing EE recurrence in Asian patients with healed EE.Trial Registration::https://clinicaltrials.gov; NCT02388737.