Frieling T
Medizinische Klinik II, Klinikum, Krefeld.
Internist (Berl). 2004 Dec;45(12):1364-9. doi: 10.1007/s00108-004-1291-7.
Because gastroesophageal reflux disease (GERD) is a motility disorder, acid reduction with proton pump inhibitors (PPI) remains a symptomatic therapy with a recurrence rate of over 90% after discontinuation of acid suppression. This "therapeutic dilemma" becomes obvious in patients not responding sufficiently to the conventional medication (therapy resistance, necessity of high PPI doses, volume reflux). In this manuscript we analyze additional factors that may play a role in the pathogenesis and interpretation of GERD. These additional factors include gastroesophageal motility and esophageal barrier functions as well as duodenogastroesophageal reflux and Helicobacter pylori infection. In addition, basic problems in interpretation of therapeutic success such as placebo effect, spontaneous remission of GERD, the role of sensory function and subjective interpretation of symptoms and the overlap between physiological and pathological reflux as well as functional disorders will be discussed.
由于胃食管反流病（GERD）是一种动力障碍性疾病，使用质子泵抑制剂（PPI）减少胃酸仍然是一种对症治疗方法，在停止抑酸治疗后复发率超过90%。这种“治疗困境”在对传统药物反应不充分的患者中（治疗抵抗、高剂量PPI的必要性、容量反流）变得很明显。在本手稿中，我们分析了可能在GERD的发病机制和解释中起作用的其他因素。这些其他因素包括胃食管动力和食管屏障功能，以及十二指肠胃食管反流和幽门螺杆菌感染。此外，还将讨论治疗成功解释中的基本问题，如安慰剂效应、GERD的自发缓解、感觉功能的作用和症状的主观解释，以及生理性和病理性反流与功能性障碍之间的重叠。
