Menezes Mariano A, Herbella Fernando A M
Department of Surgery, State University of Londrina, Londrina, Brazil.
Department of Surgery, Escola Paulista de Medicina, Federal University of São Paulo, Rua Diogo de Faria 1087 cj 301, São Paulo, SP, 04037-003, Brazil.
World J Surg. 2017 Jul;41(7):1666-1671. doi: 10.1007/s00268-017-3952-4.
Gastroesophageal reflux disease pathophysiology is multifactorial and linked to a misbalance between the aggressiveness of the refluxate into the esophagus or adjacent organs and the failure of protective mechanisms associate or not to a defective valvular mechanism at the level of the esophagogastric junction incapable of dealing with a transdiaphragmatic pressure gradient. Antireflux mechanisms include the lower esophageal sphincter and abdominal esophagus, the diaphragm, the angle of His, the Gubaroff valve, and the phrenoesophageal membrane. Protective mechanisms include esophageal motility, saliva production, and epithelial protection. Disruption of this balance occurs most commonly due to the presence of a hiatal hernia, esophageal dysmotility, a rise in abdominal pressure (obesity), and decrease in thoracic pressure (chronic lung diseases).
胃食管反流病的病理生理学是多因素的，与反流物进入食管或邻近器官的侵袭性以及保护机制的失效有关，保护机制的失效与食管胃交界处瓣膜机制缺陷有关，该缺陷无法应对跨膈肌压力梯度。抗反流机制包括食管下括约肌和腹段食管、膈肌、His角、Gubaroff瓣和膈食管膜。保护机制包括食管蠕动、唾液分泌和上皮保护。这种平衡的破坏最常见于存在食管裂孔疝、食管运动障碍、腹压升高（肥胖）和胸压降低（慢性肺部疾病）的情况。
