Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, UK.
J Neurogastroenterol Motil. 2010 Jul;16(3):258-64. doi: 10.5056/jnm.2010.16.3.258. Epub 2010 Jul 27.
Patients that do not respond satisfactorily to standard proton pump inhibitor (PPI) treatment have become the most common presentation of gastro-esophageal reflux disease (GERD) in third referral gastrointestinal practices. The causes of refractory GERD include lack of compliance with treatment, residual acid reflux and weakly acidic reflux, esophageal hypersensitivity and persistent symptoms not associated with reflux. A role for weakly acidic reflux in symptom generation has been proposed since the availability of impedance-pH monitoring. The possible mechanisms by which persistent weakly acidic reflux might contribute to persistent symptoms in patients under PPI treatment may include esophageal distension by increased reflux volume, persistent impaired mucosal integrity (ie, dilation of intercellular spaces) and/or esophageal hypersensitivity to weakly acidic reflux events. To establish a definite role of weakly acidic reflux in refractory GERD, outcome studies targeting this type of reflux are still lacking. Treatment strategies to reduce the number or effect of weakly acidic reflux could involve drugs that decrease transient lower esophageal sphincter relaxations (ie, baclofen or similar), improve oesophageal mucosa resistance or visceral pain modulators. Finally, anti-reflux surgery can be considered, only if a clear symptom-weakly acidic reflux association was demonstrated.
在第三转诊胃肠病学实践中，不能令人满意地对标准质子泵抑制剂 (PPI) 治疗有反应的患者已成为胃食管反流病 (GERD) 最常见的表现。难治性 GERD 的原因包括治疗依从性差、残留胃酸反流和弱酸性反流、食管高敏性和与反流无关的持续症状。自从阻抗-pH 监测可用以来，人们提出了弱酸性反流在症状产生中的作用。在接受 PPI 治疗的患者中，持续的弱酸性反流可能通过增加反流量导致食管扩张、持续的粘膜完整性受损（即细胞间空间扩张）和/或对弱酸性反流事件的食管高敏性，从而导致持续症状。为了确定弱酸性反流在难治性 GERD 中的明确作用，针对这种类型反流的疗效研究仍然缺乏。减少弱酸性反流次数或效果的治疗策略可能包括减少短暂性食管下括约肌松弛的药物（即巴氯芬或类似物）、改善食管粘膜阻力或内脏痛调节剂。最后，如果明确证明症状与弱酸性反流之间存在关联，可以考虑抗反流手术。
