Freys S M, Heimbucher J
Chirurgische Klinik, Interdisziplinäres Bauchzentrum, Darmkrebszentrum Bremen West, DIAKO Ev. Diakonie-Krankenhaus gGmbH, Gröpelinger Heerstr. 406-408, 28239, Bremen, Deutschland,
Chirurg. 2014 Dec;85(12):1046-54. doi: 10.1007/s00104-014-2804-0.
Approximately 20 % of the population are affected by gastroesophageal reflux disease (GERD). The subjective clinical and objective pathological extent of the disease is highly variable and the underlying pathophysiological mechanisms extraordinarily diverse. The importance of hiatus hernia for GERD has been intensively debated for decades. Hiatus hernia was initially considered to be at the center of the pathophysiology but later the function of the lower esophageal sphincter was increasingly considered to be of importance. Currently, additional relevant pathophysiological cofactors are being detected with the continuous improvement in diagnostic methods and used for therapeutic decision-making. Despite standardization of the operative technique and increasing criticism on long-term proton pump inhibitor (PPI) therapy, antireflux surgery still requires a very critical assessment of indications based on a comprehensive diagnostic evaluation.
大约20%的人口受到胃食管反流病（GERD）的影响。该疾病的主观临床和客观病理程度差异很大，其潜在的病理生理机制也极为多样。几十年来，食管裂孔疝对GERD的重要性一直存在激烈争论。食管裂孔疝最初被认为是病理生理学的核心，但后来食管下括约肌的功能越来越被认为很重要。目前，随着诊断方法的不断改进，正在检测到其他相关的病理生理辅助因素，并将其用于治疗决策。尽管手术技术已经标准化，且对长期质子泵抑制剂（PPI）治疗的批评越来越多，但抗反流手术仍需要基于全面诊断评估对适应证进行非常严格的评估。
