Farrokhi F, Vaezi M F
Division of Gastroenterology and Hepatology, Center for Swallowing and Esophageal Disorders, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Oral Dis. 2007 Jul;13(4):349-59. doi: 10.1111/j.1601-0825.2007.01380.x.
Gastroesophageal reflux disease (GERD) is a common medical condition affecting approximately 35-40% of the adult population in the western world. The role of GERD in causing extra-esophageal symptoms including laryngitis, asthma, cough, chest pain, and dental erosions is increasingly recognized with renewed interest among gastroenterologists and other specialists. Direct injury by mucosal contact, and vagally mediated reflex from distal esophageal acid exposure are the two possible mechanisms by which reflux-related extra-esophageal tissue injuries may occur. Several investigational techniques may be used to diagnose gastroesophageal reflux; however, because of the poor sensitivity of endoscopy and pH monitoring, and the poor specificity of laryngoscopy, empiric therapy with proton-pump inhibitors (PPI) is now considered the initial diagnostic step in patients suspected of having GERD-related symptoms. In those who improve with such therapy, it is likely that GERD may be the cause of the extra-esophageal presentation. In those who are unresponsive to such therapy, other diagnostic testing such as impedance/pH monitoring may be reasonable in order to exclude continued acid or weakly acid reflux. However, PPI-unresponsive patients usually have causes other than GERD for the extra-esophageal symptoms and signs.
胃食管反流病（GERD）是一种常见的病症，在西方世界约35%-40%的成年人口中存在。GERD在引发食管外症状（包括喉炎、哮喘、咳嗽、胸痛和牙齿侵蚀）方面的作用越来越受到胃肠病学家和其他专家的重新关注和认可。黏膜接触造成的直接损伤以及远端食管酸暴露引起的迷走神经介导反射是反流相关食管外组织损伤可能发生的两种机制。可采用多种检查技术来诊断胃食管反流；然而，由于内镜检查和pH监测的敏感性较差，以及喉镜检查的特异性较差，质子泵抑制剂（PPI）经验性治疗目前被视为疑似有GERD相关症状患者的初始诊断步骤。在接受此类治疗后症状改善的患者中，GERD很可能是食管外表现的病因。在对这种治疗无反应的患者中，为了排除持续的酸或弱酸反流，进行其他诊断测试（如阻抗/pH监测）可能是合理的。然而，对PPI无反应的患者食管外症状和体征的病因通常不是GERD。
