Review article: acidity and volume of the refluxate in the genesis of gastro-oesophageal reflux disease symptoms
Review article: acidity and volume of the refluxate in the genesis of gastro-oesophageal reflux disease symptoms
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DOI：
10.1111/j.1365-2036.2007.03281.x
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发表时间：
2007-05-01
影响因子：
7.6
通讯作者：
Gregersen, H.
中科院分区：
文献类型：
--
作者：
Sifrim, D.;Mittal, R.;Gregersen, H.
背景胃食管反流病的症状可能与多种机制有关，而不是与酸反流有关。目的探讨非酸反流机制的重要性。方法本综述基于一次研讨会的报告和讨论，该领域的专家分析了与这些机制有关的数据。结果弱酸性反流，pH（4-7），阻抗-pH测定法检测到的与反流和非典型胃食管反流病症状相关。胃蛋白酶和胰蛋白酶是否会引起症状尚不清楚，但胆汁可引起胃灼热。反流引起的食管扩张的程度可以通过高频超声检查确定，并且不会因质子泵抑制剂而减少，这表明质子泵抑制剂“上”的持续症状可能仍然是由于非酸性反流引起的食管扩张。过度的纵向肌肉收缩可诱发非酸相关性胃灼热。初步研究表明，巴氯芬，手术或内窥镜手术，以减少弱酸reflux.Conclusions机制以外的酸反流参与胃食管反流病的一些症状的积极影响。需要进行对照结局研究，以阐明它们的作用和质子泵抑制剂治疗期间持续症状患者抗反流手术的适应症。
Background A number of mechanisms, other than acid reflux, may be responsible for the symptoms of gastro-oesophageal reflux disease.Aim To assess the importance of non-acid reflux mechanisms.Methods This review is based on presentations and discussion at a workshop, where specialists in the field analysed data relating to these mechanisms.Results Weakly acidic reflux, pH (4-7), detected with impedance-pHmetry is associated with regurgitation and atypical gastro-oesophageal reflux disease symptoms. It is not clear whether pepsin and trypsin can elicit symptoms, but bile can elicit heartburn. The magnitude of reflux-induced oesophageal distension can be determined by high frequency ultrasonography and is not reduced by proton pump inhibition, suggesting that persisting symptoms 'on' a proton pump inhibitor may still be due to oesophageal distension by non-acidic reflux. Exaggerated longitudinal muscle contraction can induce non-acid-related heartburn. Preliminary studies showed a positive effect of baclofen, surgery or endoscopic procedures to reduce weakly acidic reflux.Conclusions Mechanisms other than acid reflux are involved in some of the symptoms of gastro-oesophageal reflux disease. Controlled outcome studies are needed to clarify their roles and the indications for antireflux procedures in patients with persistent symptoms whilst 'on' a proton pump inhibitor.