Richter Joel E.
Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, 9500 Euclid Avenue, S-40, Cleveland, OH 44195, USA.
Curr Treat Options Gastroenterol. 2004 Feb;7(1):53-58. doi: 10.1007/s11938-004-0025-1.
Duodenogastric reflux is the retrograde flow of duodenal contents into the stomach that then mix with acid and pepsin. These agents can reflux into the esophagus (ie, duodenogastroesophageal reflux ) and cause gastroesophageal reflux disease (GERD) and its complications, including stricture, Barrett's esophagus, and adenocarcinoma of the esophagus. Medical and surgical treatments of DGER can be difficult. Best medical treatment is proton-pump inhibitors, which decrease DGER by inhibiting both gastric acidity and volume, making less gastric contents available to reflux into the esophagus. The addition of the gamma-aminobutyric (GABA(B)) receptor agonist baclofen may further reduce DGER in patients not responding to proton-pump inhibitors. Bile acid-binding agents (aluminum-containing antacids, cholestyramine, sucralfate, urosodeoxycholic acid) have physiologic rationale, but their efficacy is unproven. Prokinetic agents can reduce DGER and its upper gastrointestinal symptoms by promoting increased gastric emptying. In patients with medically refractory symptoms, a Roux-en-Y diversion or duodenal switch operation may be helpful.
十二指肠-胃反流是十二指肠内容物逆行流入胃内，并与胃酸和胃蛋白酶混合的现象。这些物质可反流至食管（即十二指肠-胃-食管反流），并引发胃食管反流病（GERD）及其并发症，包括食管狭窄、巴雷特食管和食管癌。十二指肠-胃-食管反流的药物和手术治疗可能具有挑战性。最佳药物治疗是质子泵抑制剂，其通过抑制胃酸分泌和减少胃容量，降低十二指肠-胃-食管反流，使反流至食管的胃内容物减少。对于对质子泵抑制剂无反应的患者，加用γ-氨基丁酸（GABA(B)）受体激动剂巴氯芬可能进一步降低十二指肠-胃-食管反流。胆汁酸结合剂（含铝抗酸剂、考来烯胺、硫糖铝、熊去氧胆酸）有其生理作用机制，但其疗效尚未得到证实。促动力药物可通过促进胃排空增加来减少十二指肠-胃-食管反流及其上消化道症状。对于药物治疗无效的患者，行Roux-en-Y转流术或十二指肠转位手术可能有效。
