Napierkowski John, Wong Roy K H
Department of Medicine, Uniformed University of the Health Sciences, Washington, DC, USA.
Am J Med Sci. 2003 Nov;326(5):285-99. doi: 10.1097/00000441-200311000-00005.
The association between gastroesophageal reflux disease (GERD) and extraesophageal disease is often referred to as extraesophageal reflux (EER). This article reviews EER, discussing epidemiology, pathogenesis, diagnosis, and treatment with a focus on the most studied and convincing EER disorders-asthma, cough, and laryngitis. Although EER comprises a heterogeneous group of disorders, some general characterizations can be made, as follows. First, although GERD's association with extraesophageal diseases is well-established, definitive evidence of causation has been more elusive, rendering epidemiological data scarce. Secondly, regarding the pathogenesis of EER, 2 basic models have been proposed: direct injury to extraesophageal tissue by acid and pepsin exposure or injury mediated through an esophageal reflex mechanism. Third, because heartburn and regurgitation are often absent in patients with EER, GERD may not be suspected. Even when GERD is suspected, the diagnosis may be difficult to confirm. Although endoscopy and barium esophagram remain important tools for detecting esophageal complications, they may fail to establish the presence of GERD. Even when GERD is diagnosed by endoscopy or barium esophagram, causation between GERD and extraesophageal symptoms cannot be determined. Esophageal pH is the most sensitive tool for detecting GERD, and it plays an important role in EER. However, even pH testing cannot establish GERD's causative relationship to extraesophageal symptoms. In this regard, effective treatment of GERD resulting in significant improvement or remission of the extraesophageal symptoms provides the best evidence for GERD's pathogenic role. Finally, EER generally requires more prolonged and aggressive antisecretory therapy than typical GERD requires.
胃食管反流病（GERD）与食管外疾病之间的关联通常被称为食管外反流（EER）。本文对EER进行综述，讨论其流行病学、发病机制、诊断和治疗，重点关注研究最多且最具说服力的EER疾病——哮喘、咳嗽和喉炎。尽管EER包含一组异质性疾病，但仍可进行一些一般性描述，如下所述。首先，虽然GERD与食管外疾病的关联已得到充分证实，但因果关系的确切证据却更难捉摸，导致流行病学数据匮乏。其次，关于EER的发病机制，已提出两种基本模型：酸和胃蛋白酶暴露对食管外组织的直接损伤或通过食管反射机制介导的损伤。第三，由于EER患者通常没有烧心和反流症状，可能不会怀疑患有GERD。即使怀疑患有GERD，诊断也可能难以证实。尽管内镜检查和食管钡餐造影仍是检测食管并发症的重要工具，但它们可能无法确定GERD的存在。即使通过内镜检查或食管钡餐造影诊断出GERD，也无法确定GERD与食管外症状之间的因果关系。食管pH值是检测GERD最敏感的工具，在EER中也起着重要作用。然而，即使pH检测也无法确定GERD与食管外症状的因果关系。在这方面，有效治疗GERD并使食管外症状显著改善或缓解，为GERD的致病作用提供了最佳证据。最后，与典型的GERD相比，EER通常需要更长期、更积极的抗分泌治疗。
