Department of Surgery, Clinical Center, University of Pécs, Medical School, 13 Ifjúság útja, Pecs, 7624, Hungary.
Department of Surgical Research and Techniques, University of Pécs, Medical School, 12 Szigeti út, Pecs, 7624, Hungary.
Dig Dis Sci. 2018 Oct;63(10):2529-2535. doi: 10.1007/s10620-018-5184-3. Epub 2018 Jul 11.
The increasing prevalence of GERD has become a major concern due to its major health and economic impacts. Beyond the typical unpleasant symptoms, reflux can also be the source of severe, potentially life-threatening complications, such as aspiration.
Our aim was to support our hypothesis that the human body may in some cases develop various protective mechanisms to prevent these conditions.
Based on our experiences and review of the literature, we investigated the potential adaptive nature of seven reflux complications (hypertensive lower esophageal sphincter, achalasia, hypertensive upper esophageal sphincter, Zenker's diverticulum, Schatzki's ring, esophageal web, and Barrett's esophagus).
Patients with progressive GERD may develop diverse structural and functional esophageal changes that narrow the lumen of the esophagus and therefore reduce the risk of regurgitation and protect the upper aerodigestive tract from aspiration. The functional changes (hypertensive lower esophageal sphincter, achalasia, hypertensive upper esophageal sphincter) seem to be adaptive reactions aimed at easing the unpleasant symptoms and reducing acid regurgitation. The structural changes (Schatzki's ring, esophageal web) result in very similar outcomes, but we consider these are rather secondary consequences and not real adaptive mechanisms. Barrett's esophagus is a special form of adaptive protection. In these cases, patients report significant relief of their previous heartburn as Barrett's esophagus develops because of the replacement of the normal squamous epithelium of the esophagus by acid-resistant metaplastic epithelium.
We believe that GERD may induce different self-protective reactions in the esophagus that result in reduced acid regurgitation or decreased reflux symptoms.
由于胃食管反流病（GERD）对健康和经济的重大影响，其患病率的不断增加已成为一个主要关注点。除了典型的不适症状外，反流还可能导致严重的、潜在危及生命的并发症，如吸入。
我们的目的是支持我们的假设，即人体在某些情况下可能会发展出各种保护机制来预防这些情况。
根据我们的经验和文献回顾，我们研究了七种反流并发症（高压性下食管括约肌、贲门失弛缓症、高压性上食管括约肌、Zenker 憩室、Schatzki 环、食管蹼和 Barrett 食管）的潜在适应性。
患有进行性 GERD 的患者可能会发展出多种结构和功能上的食管变化，这些变化会使食管腔变窄，从而降低反流的风险，并保护上呼吸道免受吸入。功能性变化（高压性下食管括约肌、贲门失弛缓症、高压性上食管括约肌）似乎是旨在缓解不适症状和减少胃酸反流的适应性反应。结构变化（Schatzki 环、食管蹼）导致非常相似的结果，但我们认为这些是继发后果，而不是真正的适应性机制。Barrett 食管是一种特殊形式的适应性保护。在这些情况下，由于正常的食管鳞状上皮被耐酸的化生上皮所取代，患者报告先前的烧心症状显著缓解，因为 Barrett 食管的发展。
我们认为，GERD 可能会在食管中引起不同的自我保护反应，从而减少胃酸反流或减轻反流症状。
