Bakhos Charles T, Petrov Roman V, Parkman Henry P, Malik Zubair, Abbas Abbas E
Department of Thoracic Medicine and Surgery, Section of Gastroenterology, Temple University Hospital, Philadelphia, PA, USA.
Department of Medicine, Section of Gastroenterology, Temple University Hospital, Philadelphia, PA, USA.
J Thorac Dis. 2019 Aug;11(Suppl 12):S1610-S1617. doi: 10.21037/jtd.2019.06.62.
Gastroesophageal reflux disease (GERD) is quite prevalent worldwide, especially in the western hemisphere. The pathophysiology of GERD is complex, involving an incompetent esophagogastric junction (EGJ) as an anti-reflux barrier, as well as other co-morbid conditions such as gastroparesis, hiatal herniation or hyper acid secretion. Esophageal dysmotility is also frequently encountered in GERD, further contributing to the disease in the form of fragmented peristalsis, ineffective esophageal motility (IEM) or the more severe aperistalsis. The latter is quite common in systemic connective tissue disorders such as scleroderma. The main stay treatment of GERD is pharmacologic with proton pump inhibitors (PPI), with surgical fundoplication offered to patients who are not responsive to medications or would like to discontinue them for medical or other reasons. The presence of esophageal dysmotility that can worsen or create dysphagia can potentially influence the choice of fundoplication (partial or complete), or whether it is even possible. Most of the existing literature demonstrates that fundoplication may be safe in the setting of ineffective or weak peristalsis, and that post-operative dysphagia cannot be reliably predicted by pre-operative manometry parameters. In cases of complete aperistalsis (scleroderma-like esophagus), partial fundoplication can be offered in select patients who exhibit prominent reflux symptoms after a comprehensive multidisciplinary evaluation. Roux-en-Y gastric bypass is an alternative to fundoplication in patients with this extreme form of esophageal dysmotility, after careful consideration of the nutritional status.
胃食管反流病（GERD）在全球范围内相当普遍，尤其是在西半球。GERD的病理生理学很复杂，涉及食管胃交界处（EGJ）作为抗反流屏障功能不全，以及其他合并症，如胃轻瘫、食管裂孔疝或胃酸分泌过多。食管动力障碍在GERD中也经常出现，以蠕动破碎、无效食管动力（IEM）或更严重的无蠕动形式进一步加重病情。后者在系统性结缔组织疾病如硬皮病中很常见。GERD的主要治疗方法是使用质子泵抑制剂（PPI）进行药物治疗，对于对药物无反应或因医疗或其他原因希望停药的患者，可进行手术胃底折叠术。存在可能加重或导致吞咽困难的食管动力障碍可能会影响胃底折叠术（部分或完全）的选择，甚至是否可行。大多数现有文献表明，在无效或微弱蠕动的情况下，胃底折叠术可能是安全的，术前测压参数不能可靠地预测术后吞咽困难。在完全无蠕动（硬皮病样食管）的情况下，经过全面的多学科评估后，对于表现出明显反流症状的特定患者，可以进行部分胃底折叠术。在仔细考虑营养状况后，Roux-en-Y胃旁路术是这种极端形式食管动力障碍患者胃底折叠术的替代方案。
