Hunt E B, Sullivan A, Galvin J, MacSharry J, Murphy D M
The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland.
The Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland.
Open Respir Med J. 2018 Jan 23;12:1-10. doi: 10.2174/1874306401812010001. eCollection 2018.
Gastro-Oesophageal Reflux (GOR) has been associated with chronic airway diseases while the passage of foreign matter into airways and lungs through aspiration has the potential to initiate a wide spectrum of pulmonary disorders. The clinical syndrome resulting from such aspiration will depend both on the quantity and nature of the aspirate as well as the individual host response. Aspiration of gastric fluids may cause damage to airway epithelium, not only because acidity is toxic to bronchial epithelial cells but also due to the effect of digestive enzymes such as pepsin and bile salts. Experimental models have shown that direct instillation of these factors to airways epithelia cause damage with a consequential inflammatory response. The pathophysiology of these responses is gradually being dissected, with better understanding of acute gastric aspiration injury, a major cause of acute lung injury, providing opportunities for therapeutic intervention and potentially, ultimately, improved understanding of the chronic airway response to aspiration. Ultimately, clarification of the inflammatory pathways which are related to micro-aspiration pepsin and bile acid salts may eventually progress to pharmacological intervention and surgical studies to assess the clinical benefits of such therapies in driving symptom improvement or reducing disease progression.
胃食管反流（GOR）与慢性气道疾病有关，而异物通过误吸进入气道和肺部有可能引发多种肺部疾病。这种误吸导致的临床综合征将取决于误吸物的数量和性质以及个体宿主反应。胃液误吸可能会损害气道上皮，这不仅是因为酸性物质对支气管上皮细胞有毒性，还由于胃蛋白酶和胆盐等消化酶的作用。实验模型表明，将这些因素直接滴注到气道上皮会导致损伤并随之引发炎症反应。这些反应的病理生理学正在逐步被剖析，随着对急性胃误吸损伤（急性肺损伤的主要原因）的更好理解，为治疗干预提供了机会，最终可能会加深对误吸引起的慢性气道反应的理解。最终，阐明与微量误吸胃蛋白酶和胆酸盐相关的炎症途径，可能最终会发展为药物干预和外科研究，以评估此类疗法在改善症状或减少疾病进展方面的临床益处。
