Savarino Vincenzo, Savarino Edoardo, Parodi Andrea, Dulbecco Pietro
Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova, Genova, Italy.
Dig Dis. 2007;25(3):172-4. doi: 10.1159/000103879.
Gastroesophageal reflux disease (GERD) is a common disorder in Western countries. For many years our attention has been focused on patients with erosive esophagitis, but in recent times we have realized that endoscopy-negative reflux disease is the most common presentation of this illness, affecting up to 70% of these individuals. Patients with the non-erosive form (NERD) are a heterogeneous group including various subpopulations with different mechanisms for their main symptom of heartburn: reflux of acidic and non-acidic gastric contents, mucosal hypersensitivity, intraesophageal distension by gas, intraduodenal infusion of fat, muscle contractions and psychological abnormalities. As to esophageal acid exposure, patients with NERD can be subdivided into those with abnormal and normal pH testing. The latter group includes patients with a positive correlation between symptoms and reflux events, in whom heartburn can be controlled by proton pump inhibitor (PPI) therapy. According to the recent Rome III criteria, they are still in the realm of GERD. An additional group is called functional heartburn, because this typical symptom is associated neither with an abnormal pH test nor with a positive symptom index. Their response to PPIs is very disappointing. Therefore, there is an increasing consensus on the fact that they do not have GERD and should be treated with drugs other than PPIs.
胃食管反流病（GERD）在西方国家是一种常见疾病。多年来，我们一直将注意力集中在糜烂性食管炎患者身上，但近年来我们意识到内镜检查阴性的反流病是这种疾病最常见的表现形式，影响着高达70%的此类患者。非糜烂性反流病（NERD）患者是一个异质性群体，包括各种亚群，其烧心这一主要症状有着不同的发病机制：酸性和非酸性胃内容物反流、黏膜超敏反应、气体导致的食管内扩张、十二指肠内注入脂肪、肌肉收缩以及心理异常。至于食管酸暴露情况，NERD患者可细分为pH测试异常和正常的患者。后一组包括症状与反流事件呈正相关的患者，他们的烧心症状可通过质子泵抑制剂（PPI）治疗得到控制。根据最近的罗马III标准，他们仍属于GERD范畴。另外还有一组被称为功能性烧心，因为这种典型症状既与pH测试异常无关，也与症状指数阳性无关。他们对PPI的反应非常令人失望。因此，人们越来越一致地认为他们没有GERD，应该用PPI以外的药物进行治疗。
