Penagini R
Cattedra di Gastroenterologia, University of Milan, IRCCS Ospedale Maggiore, Italy.
Eur J Gastroenterol Hepatol. 2001 Jan;13(1):1-3. doi: 10.1097/00042737-200101000-00001.
Duodenal contents, and especially bile acids and trypsin, are noxious to the oesophageal mucosa, their damaging potential depending on pH. Various methodologies have been used to measure duodenogastric or duodenogastro-oesophageal reflux, all of them having technical limitations. Controversy exists as to the extent of duodenogastric reflux in GORD. Reflux of both acid and duodenal contents into the oesophagus increases with worsening of oesophagitis. Experimental data suggest that bile acids and trypsin are noxious to the oesophageal mucosa and that their damaging potential depends on pH. The injurious concentrations are, however, higher than those usually observed in the human oesophagus. Direct measurement of bile acids and trypsin is difficult and various methodologies have been used to measure duodenogastric or duodenogastro-oesophageal reflux, all of them having technical limitations. Whereas available data as to the extent of duodenogastric reflux in gastro-oesophageal reflux disease (GORD) are controversial, most observations show that reflux of both acid and duodenal contents into the oesophagus increases with worsening of oesophagitis. Furthermore, acid and duodenal contents occur simultaneously in most reflux episodes. In this issue of the journal, Marshall et al. report that exposure of the gastric fundus to duodenal contents as assessed by bilirubin monitoring is similar in GORD patients with varying degrees of oesophageal mucosal injury and in healthy controls.
十二指肠内容物，尤其是胆汁酸和胰蛋白酶，对食管黏膜有害，其损害潜能取决于pH值。已采用多种方法来测量十二指肠胃反流或十二指肠胃食管反流，所有这些方法都存在技术局限性。关于胃食管反流病（GORD）中十二指肠胃反流的程度存在争议。随着食管炎加重，酸和十二指肠内容物向食管的反流均增加。实验数据表明，胆汁酸和胰蛋白酶对食管黏膜有害，且其损害潜能取决于pH值。然而，其有害浓度高于通常在人体食管中观察到的浓度。直接测量胆汁酸和胰蛋白酶很困难，已采用多种方法来测量十二指肠胃反流或十二指肠胃食管反流，所有这些方法都存在技术局限性。尽管关于胃食管反流病（GORD）中十二指肠胃反流程度的现有数据存在争议，但大多数观察结果表明，随着食管炎加重，酸和十二指肠内容物向食管的反流均增加。此外，在大多数反流发作中，酸和十二指肠内容物同时出现。在本期杂志中，马歇尔等人报告称，通过胆红素监测评估，不同程度食管黏膜损伤的GORD患者和健康对照者胃底暴露于十二指肠内容物的情况相似。
