Falk G W
Department of Gastroenterology, Center for Swallowing and Esophageal Disorders, The Cleveland Clinic Foundation, OH 44195, USA.
Semin Gastrointest Dis. 2001 Jul;12(3):186-95.
A variety of abnormalities contribute to the development of gastroesophageal reflux disease (GERD) including transient lower esophageal sphincter relaxation, low esophageal sphincter pressure, presence of a hiatal hernia, diminished esophageal clearance of refluxed gastric contents, and alterations in esophageal mucosal resistance. Helicobacter pylori infection clearly plays a role in the pathogenesis of peptic ulcer disease and mucosa associated lymphoma of the stomach and is a definite risk factor for distal gastric cancer. The role of H. pylori infection in GERD remains controversial and incompletely understood. Although H. pylori infection does not cause reflux disease, circumstantial evidence suggests that it may protect against the development of GERD and its complications in some patients. The most likely mechanism whereby H. pylori infection protects against GERD is by decreasing the potency of the gastric refluxate in patients with corpus predominant gastritis. A variety of implications of H. pylori infection on GERD treatment have also arisen in recent years. These focus on the risk of gastric atrophy while on proton pump inhibitor therapy and the efficacy of proton pump inhibitors before and after eradication of H. pylori. This article puts into perspective our current understanding of the complex, incompletely understood relationship between H. pylori infection and GERD.
多种异常因素导致胃食管反流病（GERD）的发生，包括食管下括约肌短暂松弛、食管下括约肌压力降低、食管裂孔疝的存在、食管对反流胃内容物清除能力减弱以及食管黏膜抵抗力改变。幽门螺杆菌感染在消化性溃疡病和胃黏膜相关淋巴瘤的发病机制中显然起作用，并且是远端胃癌的明确危险因素。幽门螺杆菌感染在胃食管反流病中的作用仍存在争议且尚未完全了解。虽然幽门螺杆菌感染不会引起反流病，但间接证据表明，它可能在某些患者中预防胃食管反流病及其并发症的发生。幽门螺杆菌感染预防胃食管反流病最可能的机制是降低胃体为主型胃炎患者胃反流物的效力。近年来，幽门螺杆菌感染对胃食管反流病治疗的各种影响也已出现。这些影响集中在质子泵抑制剂治疗期间胃萎缩的风险以及根除幽门螺杆菌前后质子泵抑制剂的疗效。本文阐述了我们目前对幽门螺杆菌感染与胃食管反流病之间复杂且尚未完全理解的关系的认识。
