Phenotypes of gastroesophageal reflux disease: classification, pathogenesis and diagnostic criteria: A review

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Abstract

The literature review focuses on the current understanding of visceral hypersensitivity mechanisms in the esophagus. Mechanisms of peripheral and central sensitization and their relation to heartburn symptoms are covered in detail. Diagnostic criteria and algorithms for non-erosive reflux disease, functional heartburn, and esophagus hypersensitivity based on pH-impedance testing and high-resolution esophageal manometry data are presented.

About the authors

Igor V. Maev

Yevdokimov Moscow State University of Medicine and Dentistry

Email: igormaev@rambler.ru
ORCID iD: 0000-0001-6114-564X

D. Sci. (Med.), Prof., Acad. RAS, Yevdokimov Moscow State University of Medicine and Dentistry

Russian Federation, Moscow

Elena V. Barkalova

Yevdokimov Moscow State University of Medicine and Dentistry

Email: maslovaalena@mail.ru
ORCID iD: 0000-0001-5882-9397

Аssistant, Yevdokimov Moscow State University of Medicine and Dentistry

Russian Federation, Moscow

Mariia A. Ovsepian

Yevdokimov Moscow State University of Medicine and Dentistry

Email: solnwshko_@mail.ru
ORCID iD: 0000-0003-4511-6704

Аssistant, Yevdokimov Moscow State University of Medicine and Dentistry

Russian Federation, Moscow

Dmitry N. Andreev

Yevdokimov Moscow State University of Medicine and Dentistry

Author for correspondence.
Email: dna-mit8@mail.ru
ORCID iD: 0000-0002-4007-7112

Cand. Sci. (Med.), Yevdokimov Moscow State University of Medicine and Dentistry

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Worldwide prevalence of symptoms of gastroesophageal reflux disease, % [3].

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3. Fig. 2. Spectrum of GERD [6].

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4. Fig. 3. Mechanisms of peripheral and central sensitization in the esophagus [27].

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5. Fig. 4. Mechanisms of visceral hypersensitivity development [21].

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6. Figure 5. Molecular mechanisms of central sensitization in the esophagus.

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7. Figure 6. Prevalence of depression and anxiety on the HADS anxiety and depression scale in NERD, FI, and GP [40].

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8. Figure 7. Diagnostic algorithm for NERD, FI, GS and GERD intersection syndrome with FI and GS ("overlap syndrome") [27].

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9. Fig. 8. Daily pH-impedance imaging (fragment). FI.

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10. Fig. 9. Daily pH-impedance imaging (fragment). Hypersensitive esophagus.

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11. Fig. 10. Mean values of IPRPV and SNBI for patients with heartburn and normal endoscopy [53].

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12. Fig. 11. High-resolution esophageal manometry: a - normal motility (1 - total NPS relaxation pressure in response to sip - 14 mm Hg, norm up to 28 mm Hg for solid catheter; 2 - total contractility of the distal segment - 2315 mm Hg/cm/s, norm 450-8000 mm Hg/cm/s - normal peristalsis); b - ineffective motility (1 - total pressure of NPS relaxation in response to sip - 11 mm Hg, normal to 28 mmHg for solid catheter; 2 - total contractility of the distal segment - 247 mmHg/cm/s, normal 450-8000 mmHg/cm/s - impaired peristalsis).

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