The Montreal definition and classification of gastroesophageal reflux disease: A global, evidence-based consensus paper
The Montreal definition and classification of gastroesophageal reflux disease: A global, evidence-based consensus paper
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DOI：
10.1055/s-2007-963633
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发表时间：
2007-11-01
影响因子：
1.3
通讯作者：
Jones, R.
中科院分区：
文献类型：
--
作者：
Vakil, N.;van Zanten, S. V.;Jones, R.
目的：研究和临床实践非常需要胃食管反流病（GERD）的世界范围内认可和接受的定义和分类。该项目的目的是制定一个可以被患者、医生和监管机构平等使用的普遍接受的定义和分类。 方法：为了确保参与专家之间达成共识，采用了采用逐步选择方式的改进德尔菲流程。为此，五人工作组在使用三个数据库（Embase、Cochrane-Study register、Medline）系统文献检索的基础上制定了一系列声明。然后这些声明经过两年的进一步发展、修改并最终作为共识获得通过。共识小组由来自18个国家的44名专家组成。每次关键投票均以六分制为基础进行。当三分之二的参与者投票赞成各自的声明时，就认为已经达成“共识”。 结果：专家之间的一致程度在多步骤决策过程中不断增加，在需要至少三分之二参与者的个人投票步骤中，结果最初是 86%，然后是 88%，一直到 94%，最后是 100% 支持所选声明。在最终投票中，最终51条声明中的94%被90%的共识组接受。 90% 的声明被一致接受或仅有少量保留。胃食管反流病被定义为一种因胃内容物反流到食道而引起麻烦症状和/或并发症的疾病。症状分为食管综合征和食管外综合征。该定义的新颖之处包括独立于内窥镜检查结果的以患者为中心的方法、将疾病分类为独立综合征以及将喉炎、咳嗽、哮喘和牙科问题考虑为可能的 GERD 综合征。此外，还提出了疑似或确诊的巴雷特食管的新定义。结论：无论该疾病的术语、语言、患病率和表现在具体国家/地区有何差异，基于证据的、世界范围内有效的共识定义都是可能的。 GERD 的全球共识定义将简化疾病管理，使相互研究成为可能，并有助于设计普遍有效的研究。这不仅对患者有帮助，而且对医生和监督机构也有帮助。
Aim: A world-wide recognised and accepted definition and classification of gastroesophageal reflux disease (GERD) would be highly desirable for research and clinical practice. The purpose of this project was to develop such a generally accepted definition and classification that could be used equally by patients, physicians, and supervisory bodies.Methods: In order to ensure a consensus among the participating experts a modifieddelphi process with a step-wise selection modality was employed. For this the working group of five persons formulated a series of statements on the basis of a systematic search of the literature using three databases (Embase, Cochrane-Study register, Medline). Then these statements were developed further for two years, revised and finally passed as consensus. The consensus group consisted of 44 experts from 18 countries. Each key vote was held on the basis of a six-point scale. A "consensus" was considered to have been reached when two-thirds of the participants voted in favour of the respective statement.Results: The level of agreement between the experts increased in the course of the multistep decision process, in the individual voting steps requiring at least two-thirds of the participants, the results were at first 86%, then 88% through to 94% and finally 100% in favour of the chosen statement. In the final voting, 94% of the final 51 statements were accepted by 90% of the consensus group. 90% of all statements were accepted unanimously or with only minor reservations. GERD was defined as a disease that is associated with troublesome symptoms and/or complications on account of reflux of stomach contents into the esophagus. The complaints are divided into esophageal and extra-esophageal syndromes. Among the novel aspects of this definition are the patient-orientated approach that is independent of endoscopic findings, the classification of the ailment into independent syndromes as well as the consideration of laryngitis, cough, asthma and dental problems as possible GERD syndromes. Furthermore, a new definition of suspected or demonstrated Barrett's esophagus is proposed.Conclusion: Irrespective of country-specific differences in terminology, language, prevalence and manifestations of this disease, evidence-based, world-wide valid consensus definitions are possible. A global consensus definition of GERD will simplify disease management, make mutual research possible and help in the design of generally valid studies. This will not only help the patient but also the physician and supervisory bodies.