2nd Department of Gastroenterology, Evangelismos Hospital, 31st street number 11, 16777 Elliniko, Athens, Greece.
Therap Adv Gastroenterol. 2011 Sep;4(5):295-300. doi: 10.1177/1756283X11409279.
In patients with proton-pump inhibitor (PPI) resistant reflux symptoms, ambulatory 24 h pH impedance monitoring can be used to assess whether a relationship exists between symptoms and reflux episodes. Using this technique it has been suggested that patients with typical reflux symptoms and a normal upper endoscopy should be subclassified as follows: normal endoscopy and abnormal distal acid esophageal exposure (patients with acid reflux); normal endoscopy, with normal distal acid esophageal exposure and a positive symptom association for either acid or nonacid reflux (patients with hypersensitive esophagus); and normal endoscopy, normal distal acid esophageal exposure and a negative symptom association for acid and nonacid reflux (patients with functional heartburn). Although for patients with a normal endoscopy and abnormal distal acid esophageal exposure more aggressive acid suppression can be recommended, managing patients with hypersensitive esophagus and functional heartburn remains a real challenge.Therefore, investigators have evaluated the role of tricyclic antidepressants or selective-serotonin reuptake inhibitors (SSRIs) in influencing esophageal perception. Imipramine has been shown to decrease pain perception in healthy male volunteers and improve symptoms of patients with chest pain and normal coronary angiograms. Trazodone improved symptoms in patients with esophageal contraction abnormalities, while administration of SSRIs lowered chemical and mechanical sensitivity and benefited patients with diffuse esophageal spasm. Furthermore, in a recent study conducted by our group, citalopram administered once daily for 6 months was effective in a select group of patients with hypersensitive esophagus, suggesting that there is a role for SSRIs in the treatment of this disorder.
在质子泵抑制剂 (PPI) 抵抗性反流症状的患者中，可使用动态 24 小时 pH 阻抗监测来评估症状与反流事件之间是否存在关系。使用该技术表明，具有典型反流症状和正常上内窥镜检查的患者应如下进行分类：正常内窥镜检查和异常远端酸食管暴露（酸反流患者）；正常内窥镜检查，正常远端酸食管暴露和酸或非酸反流的症状关联阳性（高敏感食管患者）；以及正常内窥镜检查，正常远端酸食管暴露和酸和非酸反流的症状关联阴性（功能性烧心患者）。尽管对于正常内窥镜检查和异常远端酸食管暴露的患者可以推荐更积极的抑酸治疗，但管理高敏感食管和功能性烧心患者仍然是一个真正的挑战。因此，研究人员评估了三环类抗抑郁药或选择性 5-羟色胺再摄取抑制剂 (SSRIs) 在影响食管感知中的作用。丙咪嗪已被证明可降低健康男性志愿者的疼痛感知，并改善胸痛和正常冠状动脉造影患者的症状。曲唑酮改善了食管收缩异常患者的症状，而 SSRIs 给药降低了化学和机械敏感性，并使弥漫性食管痉挛患者受益。此外，在我们小组进行的一项最近研究中，西酞普兰每天一次给药 6 个月对高敏感食管的一组选定患者有效，这表明 SSRIs 在治疗这种疾病方面具有作用。
