Dubois A
J Clin Gastroenterol. 1986;8 Suppl 1:17-25. doi: 10.1097/00004836-198606001-00005.
This review critically evaluates the gastroduodenal factors that may play a clinically relevant role in the pathogenesis of reflux esophagitis. The gastroesophageal pressure gradient is of obvious importance, but the role of gastric contraction/relaxation is poorly understood. The intragastric volume, as well as the factors that influence it, could theoretically play a role in gastroesophageal reflux (GER). For example, suppression of gastric emptying and gastric motility would be expected to increase GER, and treatment with gastrokinetic agents appears to provide symptomatic improvement. However, only a fraction of patients with GER have delayed gastric emptying, and there is no correlation between either subjective epigastric fullness or esophagitis on one hand and gastric emptying on the other hand. Gastric acid and pepsin, and possibly the hypersecretion of acid, play a pivotal role in reflux esophagitis, as demonstrated by the efficacy of the treatment with histamine H2 antagonists and antacids. Other important factors in experimental esophagitis are duodenogastric reflux, the presence of bile acids in the gastric contents, as well as trypsin if the pH is alkaline. It is suggested that these important findings may lead to novel therapeutic approaches of reflux esophagitis.
本综述批判性地评估了可能在反流性食管炎发病机制中发挥临床相关作用的胃十二指肠因素。胃食管压力梯度显然很重要，但胃收缩/舒张的作用却了解甚少。胃内体积及其影响因素理论上可能在胃食管反流（GER）中发挥作用。例如，预计胃排空和胃动力受抑制会增加GER，而使用促胃肠动力药物治疗似乎能改善症状。然而，只有一小部分GER患者存在胃排空延迟，而且主观上的上腹部饱胀感或食管炎与胃排空之间均无相关性。胃酸和胃蛋白酶，以及可能存在的胃酸分泌过多，在反流性食管炎中起关键作用，组胺H2拮抗剂和抗酸剂治疗的疗效已证明了这一点。实验性食管炎中的其他重要因素包括十二指肠胃反流、胃内容物中胆汁酸的存在，以及pH呈碱性时胰蛋白酶的存在。有人认为，这些重要发现可能会带来反流性食管炎的新治疗方法。
