胃食管反流病的病因和发病机制

胃食管反流病(GERD)是指胃、十二指肠内容物反流入食管引起反酸、烧心等症状,系因抗反流防御机制削弱,反流物起攻击作用所致,可导致反流性食管炎(RE)和/或食管外组织损害。临床上仅不到1/3的GERD为RE,其余为非糜烂性反流病(NERD)。但近年研究显示,部分NERD也有内镜下食管炎症性改变。流行病学资料表明,GERD不仅在西方国家常见,在我国亦不少见,其发病与多种因素有关(见表1)。Fass等根据近年来的研究,提出NERD、RE和Barrett食管为GERD发病的3个独立类型,三者的病理生理机制不同,较少发生相互转变。这一概念的提出对深入研究     

胃食管反流病的病因和发病机制

本文评析了胃食管反流病（GERD）的病因和发病机制的新进展,对GERD的深入研究和临床诊治具有重要指导和促进作用。     

胃食管反流病的诊断及治疗——胃食管反流病的病因与发病机理

胃食管反流病 (GERD)是指胃、十二指肠内容物反流入食管 ,引起烧心、胸痛、反酸等症状 ,导致食管炎及食管外组织损伤。 GERD是一种酸相关疾病 ,研究表明 ,GERD伴有酸反流 ,但常不伴有胃酸分泌增多 ,实际上是酸的错位。目前已认识到 ,GERD是多种因素促成的上消化道动力障碍性疾病 ,是抗反流防御机制下降和反流物对食管粘膜攻击力增强的结果 ,其中食管下括约肌 (L ES)功能失调起重要作用。现将GERD的主要病因及发病机理分述如下。1　 L ES压力低下或缺乏、L ES频发松弛患者的 L ES张力低下 ,当 L ES基础压力≤ 1.3k Pa(10 mm H…     

老年人胃食管反流性疾病的研究现状

胃食管反流性疾病是胃、十二指肠的内容物自发性反流引起食管粘膜损伤，其发病与食道下端括约肌短暂和／或持久的松弛有关。其患病率在一定群体中随年龄而增加。临床表现多样且轻重不一。病史可提示诊断，但需做进一步检查。２４小时食道内ｐＨ检查是诊断胃食管反流性疾病的最敏感的试验。治疗包括调整生活方式，无效后可根据症状和食管炎的严重程度决定选用抗酸剂、Ｈ２受体阻滞剂、质子泵抑制剂等。严重的难治病例可外科手术。     

胃食管反流病

胃食管反流病徐大毅山西医科大学附一院太原０３００１３胃食管反流（ＧａｓｔｒｏｅｓｏｐｈａｇｅａｌＲｅｆｌｕｘ，ＧＥＲ）分为两种：生理性反流：多发生于睡眠时，反流时间短，２４小时反流少于５０次，食管内ＰＨ小于４总时间少于１小时；病理性反流：２４小时内反...     

胃食管反流性疾病的研究进展

胃食管反流病(GERD)是由于胃、十二指肠内容物反流入食管引起反酸、烧心等症状或组织损害，常合并食管炎。北京、上海两地对5000例18--70岁普通人群的流行病学调查显示^[1、2]，胃食管反流(GER)症状发生率为8．97％，GERD的患病率为5．77％，反流性食管炎(RE)的发生率为1．92％。     

十二指肠胃食管反流在胃食管反流病中的作用

目的　研究十二指肠胃食管反流 (DGER)在胃食管反流病发病机制中的作用及其对非糜烂性反流病 (NERD)的诊断价值。方法　 95例患者根据内镜检查的结果分为反流性食管炎和NERD组 ,对其均进行 2 4h食管 pH和胆汁联合监测。 结果　反流性食管炎患者DGER的各项指标 :吸光度值 >0 14时间百分比 (% )、总反流次数和反流 >5min的次数分别为 19 0 5± 2 3 4 4、30 5 6±34 0 4和 5 90± 6 37,均显著高于NERD组相应的 7 2 6± 11 0 8、15 6 8± 2 0 92和 2 5 9± 3 5 7(P <0 0 5 ) ,而酸反流差异无显著性 ,随着反流性食管炎的程度加重DGER发生率增高 ;18 2 %的NERD患者存在单纯DGER ,联合胆汁监测可使NERD诊断阳性率由 6 5 9%升高到 84 1%。结论　DGER可以单独发生 ,在引起反流性食管黏膜损伤或症状方面都有作用 ,2 4h食管 pH和胆汁联合监测有助于NERD的诊断。     

胃食管反流病发病机制研究进展

胃食管反流病(GERD)是一种临床常见病,迄今为止其发病机制尚未阐明。此文就近年来GERD发病机制的研究进展作一综述,有助于采取更合理的治疗。     

胃食管反流病消化道外症状发病机制与诊治

胃食管反流病 (GERD)的症状不仅仅局限于消化道 ,通常还累及消化道外的咽喉部、肺部等 ,表现为慢性咳嗽、声音嘶哑、咽部异物感、哮喘等。GERD消化道外症状的发生机制主要包括迷走神经反射、气道微吸入、反流物直接刺激以及神经肽的参与等。其诊断与治疗更存在不少难度 ,故而成为近年来新的研究热点。     

Genetic factors in the pathogenesis of gastroesophageal reflux disease

Multiple factors play a role in the pathogenesis of gastroesophageal reflux disease (GERD). Two landmark studies showing higher concordance of disease in monozygotic than dizygotic twin pairs suggested the role of host genetic factors in its pathogenesis. Recent studies have shown that genetic polymorphism in genes influencing host’s inflammatory response, drug metabolism, cell cycle regulation, xenobiotic pathways, DNA repair, mutagenesis, esophageal sensory function and gene silencing are associated with risk of GERD and its sequelae—Barrett’s esophagus and esophageal adenocarcinoma. However, more studies on larger sample size are needed before reaching a definite conclusion on the role of an individual gene.     

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目的探讨非糜烂性胃食管反流病不同于反流性食管炎的发病机制。方法选择1996～2004年北京大学人民医院因反酸、胃灼热感等反流症状确诊为胃食管反流病患者57例,按照内镜下食管黏膜有无破损分为非糜烂性胃食管反流病组和反流性食管炎组,比较两组的一般情况、反流症状、是否合并H.pylori(Hp)感染,以及食管动力测定和食管胃24hpH监测结果。结果两组患者年龄、性别、烟酒嗜好等一般情况及合并Hp感染情况比较差异无显著性。非糜烂性胃食管反流病组不典型反流症状(胸骨后痛)的发生率明显高于反流性食管炎组。两组患者都存在病理性酸反流,但两组患者之间酸和(或)碱反流比较无差异。非糜烂性胃食管反流病患者的食管体部各段蠕动波峰值明显高于反流性食管炎患者。非糜烂性胃食管反流病患者卧位胃酸分泌高于反流性食管炎患者。结论非糜烂性胃食管反流病的不典型反流症状发生率更高。在两组发病机制异同上,反流的强弱并非主要因素,重要的是食管防御机制的差别。     

胃食管反流病的发病机制及非药物治疗的进展

胃食管反流病(gastroesophageal reflux d isease,GERD)是上胃肠道动力障碍性疾病。目前对其发病机制已经达成一定共识:即抗反流的防御机制下降和反流物对食管黏膜的侵袭作用加强,同时认为GERD是由多种因素共同促成,如:(1)十二指肠胃内容物是攻击因子;(2)机体抗反流机制出现问题(LES压下降);(3)胃电起搏系统Cajal细胞网络组织病变,电节律紊乱,协调运动能力下降;(4)食管黏膜耐受反流物刺激及损伤后修复功能缺损。其中以食管下括约肌(LES)功能失调起重要作用。近几年关于其发病机制的研究及非药物治疗又有了新的进展。胃食管反流病发病…     

Prevalence of gastroesophageal reflux disease and gastroesophageal reflux disease symptoms in Japan

BACKGROUND AND AIM: Epidemiological studies have shown that 10-48% of people in developed countries have gastroesophageal reflux disease (GERD) symptoms such as heartburn and acid regurgitation. The present study aimed to examine the prevalence of GERD symptoms and GERD in Japanese subjects. METHODS: A cross-sectional study of Japanese subjects who visited a clinic for a routine health check up was carried out. Subjects were asked to fill out a self-report questionnaire. GERD was defined as the presence of heartburn and/or acid regurgitation at least twice per week. RESULTS: Of the 6035 eligible subjects, 2662 (44.1%) reported having had heartburn and/or acid regurgitation during the past year: 124 (2.1%) daily, 275 (4.6%) twice per week, 773 (12.8%) twice per month and 1490 (24.7%) less than twice per month. Three hundred and ninety-nine (6.6%) subjects were diagnosed as having GERD and there was no relationship between the prevalence of GERD and either sex or age. The prevalence of bothersome GERD symptoms was significantly higher in subjects with GERD than in those without GERD. CONCLUSION: Approximately 6.6% of Japanese have GERD and most persons with GERD described heartburn or acid regurgitation as bothersome.     

Prevalence of gastroesophageal reflux disease and gastroesophageal reflux disease symptoms in Japan

Background and Aim:  Epidemiological studies have shown that 10–48% of people in developed countries have gastroesophageal reflux disease (GERD) symptoms such as heartburn and acid regurgitation. The present study aimed to examine the prevalence of GERD symptoms and GERD in Japanese subjects.
Methods:  A cross-sectional study of Japanese subjects who visited a clinic for a routine health check up was carried out. Subjects were asked to fill out a self-report questionnaire. GERD was defined as the presence of heartburn and/or acid regurgitation at least twice per week.
Results:  Of the 6035 eligible subjects, 2662 (44.1%) reported having had heartburn and/or acid regurgitation during the past year: 124 (2.1%) daily, 275 (4.6%) twice per week, 773 (12.8%) twice per month and 1490 (24.7%) less than twice per month. Three hundred and ninety-nine (6.6%) subjects were diagnosed as having GERD and there was no relationship between the prevalence of GERD and either sex or age. The prevalence of bothersome GERD symptoms was significantly higher in subjects with GERD than in those without GERD.
Conclusion:  Approximately 6.6% of Japanese have GERD and most persons with GERD described heartburn or acid regurgitation as bothersome.     

胃食管反流病问卷对胃食管反流病的诊断价值

目的 评价胃食管反流病问卷(GerdQ)在胃食管反流病(GERD)患者中的诊断价值,初步探讨中国GERD人群的症状特点.同时探索一种适合中国人群的质子泵抑制剂(PPI)试验的诊断标准.方法 在全国五家医院进行多中心研究.所有入组患者填写GerdQ问卷表.以胃镜检查、24 h食管pH监测和PPI试验其中任何一项阳性作为GERD的诊断标准,评价GerdQ的诊断价值.以拟定PPI试验诊断标准与胃镜和食管pH监测的诊断相比较,并优化PPI试验的诊断标准.结果 拟定PPI试验诊断的敏感度为0.6627,特异度为0.4872.经统计分析,以PPI治疗1周最后3 d烧心、反流症状总评分较治疗前相比下降3分为优化PPI试验诊断标准,诊断的敏感度为0.3787,特异度为0.8077,阳性预测值为0.8101,阴性预测值为0.3750,Youden指数最大为0.1864.经人群矫正,GerdQ取临界值为10分时,Youden指数达到最大0.1080,诊断的敏感度为0.6690,特异度为0.4390.50岁以上女性患者随着评分的增高,问卷诊断价值下降.结论 GerdQ具有肯定的诊断价值.但在临床工作中,对特殊人群中症状突出而PPI诊断性治疗反应不佳的患者,GERD的诊断应慎重.PPI试验的评分以治疗1周最后3 d为佳.     

Duodenogastral reflux burden gastroesophageal reflux disease

The article presents research data of duodenogastral reflux (DGR) role in patients with gastroesophageal reflux disease. It is shown that in the presence DGR, the reflux esophagitis is detected at a higher frequency and outside of esophageal manifestations of the disease. The comorbidities of hepatobiliary zone and pancreas contributes to the DGR development, as well as the syndrome of bacterial overgrowth in the small intestine.     

无效食管运动在胃食管反流病中发病作用的观察

目的　探讨食管无效收缩 (IEM)在胃食管反流病 (GERD)的发病作用。方法　对GERD病人行食管测压和 2 4h食管pH监测 ,分析IEM在GERD的发生率以及比较IEM与食管酸暴露、酸清除和食管炎的关系。结果　 86例GERD病人中 5 9例 (6 8 6 % )存在非特异性食管动力障碍 (NEMD) ;其中 5 5例 (占 93 2 % )符合IEM诊断标准 ;GERD病的IEM发生率为 6 3 95 %。IEM的GERD患者总的pH <4时间 (% ) (5 91)及立位 (4 4 3)和卧位 (6 92 )pH <4时间 (% )显著大于食管正常蠕动的GERD患者 (分别为 3 16 ,1.6 1,和 4 31) ,尤以卧位明显 (P <0 0 1)。IEM患者平均卧位食管酸清除时间 (EAC)为每次 12 6 3min ,显著长于正常食管动力GERD患者的每次 3 15min(P<0 0 1) ,而立位EAC则与正常食管动力组无差异。 2 7例正常食管动力GERD有 10例 (37% )有糜烂性食管炎 ;5 5例IEM患者有 19例 (35 % )有食管炎 ,二组间食管炎发生比例差异无显著性 (P >0 0 5 )。结论　GERD病的食管动力障碍大多数系IEM。IEM比正常食管动力患者更易发生反流和存在食管酸清除障碍。IEM是GERD病的主要异常表现。