Pathophysiology of gastroesophageal reflux disease
Pathophysiology of gastroesophageal reflux disease
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DOI：
10.1097/mcg.0b013e31815d0628
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发表时间：
2008-05-01
影响因子：
2.9
通讯作者：
Orlando, Roy C.
中科院分区：
文献类型：
--
作者：
Orlando, Roy C.
胃食管反流病的病理生理机制尚不完全清楚。其标志性症状是“胃灼热”，根据内窥镜检查，胃灼热可细分为非糜烂性反流病和糜烂性食管炎。虽然非糜烂性反流疾病的受试者在内镜检查中没有明显的损害，但在内镜活检中存在这种疾病的典型组织病理学特征。这种病变被称为“扩张性细胞间隙”，是鳞状上皮内的一种发现。本报告详细介绍了酸如何与受损的食管上皮接触导致胃灼热和非糜烂性反流疾病进展为糜烂性食管炎。它还解决了一个事实，即食管pH值监测可能是正常的，在相当数量的胃灼热的受试者中，特别是在非糜烂性反流疾病中，并详细说明了这一观察结果如何表明，除了抗反流屏障的缺陷，例如，短暂的食管下括约肌松弛和食管下括约肌压力低，在一些胃食管反流病患者中，与摄入的产品接触而产生的组织抵抗力缺陷也可能是病因性的。
The pathophysiology of gastroesophageal reflux disease remains incompletely understood. Its hallmark symptom is "heartburn" and, on the basis of endoscopy, those with heartburn are subdivided into nonerosive reflux disease and erosive esophagitis. Although subjects with nonerosive reflux disease have no gross damage on endoscopy, a characteristic histopathologic feature of this disease is present on endoscopic biopsy. This lesion is known as "dilated intercellular spaces," a finding present within squamous epithelium. This report details how acid in contact with a damaged esophageal epithelium leads to heartburn and to the progression of nonerosive reflux disease to erosive esoohagitis. It also addresses the fact that esophageal pH monitoring may be normal in a significant number of subjects with heartburn, particularly with nonerosive reflux disease, and details how this observation suggests that in addition to defects in the antireflux barrier, for example, transient lower esophageal sphincter relaxations and low lower esophageal sphincter pressure, defects in tissue resistance created by contact with ingested products may also be etiologic in some subjects with gastroesophageal reflux disease.