Complications of gastroesophageal reflux disease. Role of the lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and duodenogastric reflux.
Complications of gastroesophageal reflux disease. Role of the lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and duodenogastric reflux.
复制标题
胃食管反流病的并发症。
DOI：
10.1097/00000658-199207000-00006
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发表时间：
1992
影响因子：
9
通讯作者：
Hinder,RA
中科院分区：
文献类型：
--
作者：
Stein,HJ;Barlow,AP;DeMeester,TR;Hinder,RA
胃食道反流病(GERD)中食道黏膜损伤的发病因素尚不清楚。对205例GERD伴不同程度粘膜损伤(无粘膜损伤92例，食管炎66例，狭窄19例，Barrett‘s食道28例)患者的下括约肌、食管酸和酸碱暴露及十二指肠胃反流过度(DGR)进行了评价。测压和24小时食道pH监测显示，机械功能缺陷(P<；0.01)或食管酸/碱暴露增加(P<；0.01)的患者与括约肌正常或仅食管酸暴露增加的患者相比，食道黏膜损伤的发生率和严重程度更高。在括约肌缺陷和食管酸/碱暴露增加的患者中，GERD的并发症尤其频繁和严重(p<；0.01)。联合监测食道和胃的pH显示，只有合并DGR的GERD患者食管碱暴露增加(p<；0.05)，而DGR更多见于有狭窄或Barrett‘s食道的GERD患者。因此，机械缺陷的下食道括约肌和被十二指肠内容物污染的酸性胃液的反流似乎是GERD黏膜损伤发生的最重要的决定因素。这就解释了为什么一些患者内科治疗失败，并支持手术重建有缺陷的括约肌作为最有效的治疗方法。
The factors contributing to the development of esophageal mucosal injury in gastroesophageal reflux disease (GERD) are unclear. The lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and the presence of excessive duodenogastric reflux (DGR) was evaluated in 205 consecutive patients with GERD and various degrees of mucosal injury (no mucosal injury, n= 92; esophagitis, n= 66; stricture, n= 19; Barrett's esophagus, n= 28). Manometry and 24-hour esophageal pH monitoring showed that the prevalence and severity of esophageal mucosal injury was higher in patients with a mechanically defective lower esophageal sphincter (p< 0.01) or increased esophageal acid/alkaline exposure (p< 0.01) as compared with those with a normal sphincter or only increased esophageal acid exposure. Complications of GERD were particularly frequent and severe in patients who had a combination of a defective sphincter and increased esophageal acid/alkaline exposure (p< 0.01). Combined esophageal and gastric pH monitoring showed that esophageal alkaline exposure was increased only in GERD patients with DGR (p< 0.05) and that DGR was more frequent in GERD patients with a stricture or Barrett's esophagus. A mechanically defective lower esophageal sphincter and reflux of acid gastric juice contaminated with duodenal contents therefore appear to be the most important determinants for the development of mucosal injury in GERD. This explains why some patients fail medical therapy and supports the surgical reconstruction of the defective sphincter as the most effective therapy.