Abstract:

Gastroesophageal reflux disease (GERD) is a common digestive system disease. Epidemiological studies show that the incidence of GERD ranges from 10% to 30% in Europe and the United States, while the incidence in China is relatively lower, at approximately 10%. In recent years, the incidence of GERD in China has shown an increasing trend. Different diagnostic methods include pH monitoring and pH-impedance testing, endoscopy, high-resolution esophageal manometry, proton pump inhibitor (PPI) test, and salivary pepsin testing. Endoscopy enables direct observation of lesions but exhibits relatively low sensitivity. PPI tests are simple and practical but cannot provide a definitive diagnosis. Questionnaires are highly subjective. Salivary pepsin testing can evaluate laryngopharyngeal reflux, but its accuracy is limited by enzyme degradation. The sensitivity and specificity of these diagnostic methods differ. Among them, questionnaires demonstrate good performance in GERD diagnosis, with a sensitivity of 77.50% and a specificity of 87.31%. Salivary pepsin tes-ting in GERD diagnosis shows a sensitivity of 73.0% and specificity of 88.3%. The PPI test is suitable for patients with typical reflux symptoms, but the response rate significantly decreases in patients with atypical symptoms. Reflux and heartburn are not exclusive to GERD. These two symptoms may also occur in other conditions, such as achalasia, functional heartburn, reflux hypersensitivity, and eosinophilic esophagitis, potentially leading to misdiagnosis in some cases. Meanwhile, GERD is a complex syndrome involving multiple pathogenic factors and pathophysiological mechanisms. When formulating treatment strategies, clinicians should adopt individualized and precision treatment tailored to the pathological and physio-logical mechanisms of patients with different clinical manifestations. In the future, with further research and the application of new technologies, individualized precision treatment will become the core of GERD management, aiming to improve patients' quality of life and reduce the recurrence rate.

Key words: Gastroesophageal reflux disease, Clinical diagnosis, pH monitoring, Endoscopy