DeMeester T R, Peters J H, Bremner C G, Chandrasoma P
Department of Surgery, University of Southern California School of Medicine, Los Angeles 90033-4612, USA.
Annu Rev Med. 1999;50:469-506. doi: 10.1146/annurev.med.50.1.469.
This chapter reviews the biology of gastroesophageal reflux disease, relating pathophysiology to medical and surgical therapy. Various definitions of the disease are presented and workable criteria are developed to identify patients with the disease. The central importance of the lower esophageal high-pressure zone as a barrier to reflux is emphasized, along with an analysis of its biomechanical alteration in disease. The composition of the refluxed gastric juice is characterized in regard to its potential for mucosal injury. Evidence is provided that cardiac-type mucosa is an acquired sequel to acid-induced squamous mucosal injury in the terminal esophagus. A hypothesis regarding the process of intestinalization of cardiac-type mucosa to form Barrett's esophagus is presented. An integrated concept of the pathophysiology of gastroesophageal reflux disease is constructed. Practical concepts regarding the treatment of gastroesophageal reflux disease are developed, based on a review of studies on the natural history of the disease and the long-term outcome of therapy.
本章回顾了胃食管反流病的生物学机制，将病理生理学与药物及手术治疗相关联。文中给出了该疾病的各种定义，并制定了可行的标准以识别患有该疾病的患者。强调了食管下高压区作为反流屏障的核心重要性，并分析了其在疾病中的生物力学改变。对反流胃液的成分进行了表征，以了解其造成黏膜损伤的可能性。有证据表明贲门型黏膜是食管末端酸性诱导的鳞状黏膜损伤的后天后遗症。提出了一个关于贲门型黏膜肠化生形成巴雷特食管过程的假说。构建了胃食管反流病病理生理学的综合概念。基于对该疾病自然史及治疗长期结果的研究综述，提出了关于胃食管反流病治疗的实用概念。
