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?指南?新进展?
难治性胃食管反流病临床指南的系统评价
谢胜1*，李建锋2，李娟2，陈广文1，刘礼剑1，刘园园1，
杨成宁1，黄晓燕1，谢洁如1，戴文杰2，陈明冰2
背景　当前，难治性胃食管反流病的发病率呈现逐年上升趋势，而难治性胃食管反流病的诊疗规范尚未形成统一的共识意见，这使得临床上对难治性胃食管反流病患者的管理变得复杂，并且不同指南对于我国患者的适用性尚有待明确。目的　系统评价难治性胃食管反流病临床指南，以期为临床使用提供参考。方法　计算机检索PubMed、EMBase、Guidelines International Network（GIN）、National Guideline Clearinghouse（NGC）、National Institute for Health and Care Excellence（NICE）、American Gastroenterology Association（AGA）和World Health Organization（WHO）官网，以及中国知网、万方数据知识服务平台、维普网及医脉通，检索时限均为2004年1月—2018年1月。由2位研究者按照纳入与排除标准独立筛选文献、提取资料。采用AGREE Ⅱ系统评价纳入指南的证据质量和推荐强度，AGREE Ⅱ评估系统包括范围和目的、参与人员、严谨性、清晰性、应用性和编辑独立性。使用组内相关系数（ICC）进行研究者间一致性检验。结果　最终纳入5篇指南，发表时间跨度为2009—2016年。其中美国2篇，日本、中国和亚太地区各1篇。5篇指南AGREE Ⅱ评价平均得分依次为“范围和目的”88.33%、“清晰性”86.66%、“严谨性”72.08%、“参与人员”69.99%、“应用性”68.33%和“编辑独立性”20.00%，指南总体推荐级别均为B级。各指南推荐意见较为一致。结论　目前世界难治性胃食管反流病指南质量一般，尤其在“编辑独立性”领域还需特别加强。我国尚未见独立的难治性胃食管反流病指南，仅有难治性胃食管反流病专家共识，且质量还有待进一步提高。应尽快制定符合我国国情的难治性胃食管反流病循证指南，以期为临床实践提供更好的诊疗措施。
胃食管反流；循证医学；指南；系统评价
10.12114/j.issn.1007-9572.2018.00.397
谢胜，李建锋，李娟，等．难治性胃食管反流病临床指南的系统评价［J］．中国全科医学，2019，22（8）：901-908．［www.chinagp.net］
XIE S，LI J F，LI J，et al．Systematic review of guidelines on the management of refractory gastroesophageal reflux disease［J］．Chinese General Practice，2019，22（8）：901-908．
Systematic Review of Guidelines on the Management of Refractory Gastroesophageal Reflux Disease　XIE Sheng1*，LI Jianfeng2，LI Juan2，CHEN Guangwen1，LIU Lijian1，LIU Yuanyuan1，YANG Chengning1，HUANG Xiaoyan1，XIE Jieru1，DAI Wenjie2，CHEN Mingbing2
1.First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine，Nanning 530001，China
2.School of Graduate，Guangxi University of Traditional Chinese Medicine，Nanning 530000，China
*Corresponding author：XIE Sheng，Professor，Chief physician，Doctoral supervisor，Master supervisor，Main research in prevention and treatment of spleen and stomach diseases with traditional Chinese medicine；E-mail：xsh916566@126.com
Background　Currently，the incidence of refractory gastroesophageal reflux disease is increasing year by year. However，there has not been a unified consensus on the diagnosis and treatment of refractory gastroesophageal reflux disease，which makes the management of patients with refractory gastroesophageal reflux disease in clinical practice complicated，and the applicability of different guidelines for Chinese patients remains to be clarified.Objective　To systematically review the methodological quality of guidelines on the management of refractory gastroesophageal reflux disease （RGERD），so as to provide a reference for clinical use.Methods　Guidelines concerning refractory gastroesophageal reflux disease were electronically retrieved in PubMed，EMBase，Guidelines International Network（GIN），National Guideline Clearinghouse（NGC），National Institute for Health and Care Excellence（NICE），American Gastroenterology Association（AGA） and World Health Organization （WHO） website，CNKI，Wanfang Data，VIP，and Medlive from January 2004 to January 2018.Two researchers independently screened literatures and extracted data according to inclusion and exclusion criteria.AGREE Ⅱ system was used to evaluate the evidence quality and recommendation level of the RGERD guidelines.The AGREE Ⅱ evaluation system included scope and purpose，participants，rigor，clarity，application and editorial independence.Intra-group correlation coefficient （ICC） was used to test consistency among evaluators.Results　Five guidelines concerning RGERD were included，with publishing time ranging from 2009 to 2016.Among 5 guidelines，2 guidelines were made by USA，1 by China，1 by Japan and 1 by Asia-Pacific region.The scores of guidelines，according to the evaluation of AGREE Ⅱ，were “scope and purpose” of 88.33%，“clarity” of 86.66%，“rigor” of 72.08%，“participants” of 69.99%，“application” of 68.33%，and “editorial independence” of 20.00%.Five guidelines were Level B.The recommendations of different guidelines were fairly the same.Conclusion　The guidelines on RGERD should be improved in the aspect of “editorial independence” in the future.There is no independent guideline for RGERD in China，but only expert consensus which also needs to be further improved.It's also urgent to develop evidence-based guidelines in line withour national situation，in order to provide better implementation in clinical practice.
1.530001广西壮族自治区南宁市，广西中医药大学第一附属医院　2.530000广西壮族自治区南宁市，广西中医药大学研究生学院
*通信作者：谢胜，教授，主任医师，博士研究生导师，硕士研究生导师，研究方向：中医药防治脾胃病；E-mail：xsh916566@126.com
Gastroesophageal reflux；Evidence-based medicine；Guidebooks；Systematic review
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