Falk G W
Center for Swallowing and Esophageal Disorders, Department of Gastroenterology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Curr Opin Gastroenterol. 1999 Jul;15(4):333-8. doi: 10.1097/00001574-199907000-00011.
Gastroesophageal reflux disease is a common clinical problem. Transient lower esophageal sphincter relaxation is central to the pathogenesis. New studies have identified the importance of nitric oxide and cholinergic pathways in modulating transient lower esophageal sphincter relaxation. Provocative information suggests that infection with Helicobacter pylori may protect patients from developing complications of gastroesophageal reflux disease. Endoscopy may be used by clinicians to tailor therapy, but an empiric trial of a proton pump inhibitor may be an alternative diagnostic approach. Nocturnal acid breakthrough during proton pump inhibitor therapy has emerged as an important new treatment concept, although its clinical importance remains unproven. Studies continue to show that laparoscopic antireflux surgery is a cost-effective treatment option for patients requiring maintenance therapy with proton pump inhibitors. However, the minimally invasive nature of the operation should not alter the indications for antireflux surgery, especially for patients with atypical symptoms.
胃食管反流病是一个常见的临床问题。一过性下食管括约肌松弛是其发病机制的核心。新的研究已经确定了一氧化氮和胆碱能途径在调节一过性下食管括约肌松弛中的重要性。有启发性的信息表明，幽门螺杆菌感染可能使患者免于发生胃食管反流病的并发症。临床医生可通过内镜检查来调整治疗方案，但质子泵抑制剂的经验性试验可能是一种替代诊断方法。尽管质子泵抑制剂治疗期间夜间酸突破的临床重要性尚未得到证实，但它已成为一个重要的新治疗概念。研究继续表明，对于需要用质子泵抑制剂进行维持治疗的患者，腹腔镜抗反流手术是一种具有成本效益的治疗选择。然而，手术的微创性质不应改变抗反流手术的适应证，尤其是对于有非典型症状的患者。
