Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri.
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California.
Ann N Y Acad Sci. 2020 Dec;1482(1):49-60. doi: 10.1111/nyas.14521. Epub 2020 Oct 31.
Diseases of the esophagus, such as gastroesophageal reflux (GER), can result in changes to mucosal integrity, neurological function, and the microbiome. Although poorly understood, both age and GER can lead to changes to the enteric nervous system. In addition, the esophagus has a distinct microbiome that can be altered in GER. Mucosal integrity is also at risk due to persistent damage from acid. Diagnostic tools, such as ambulatory pH/impedance testing and esophageal mucosal impedance, can assess short-term and longitudinal GER burden, which can also assess the risk for mucosal compromise. The quality of the mucosal barrier is determined by its intercellular spaces, tight junctions, and tight junction proteins, which are represented by claudins, occludins, and adhesion molecules. Fortunately, there are protective factors for mucosal integrity that are secreted by the esophageal submucosal mucous glands and within saliva that are augmented by mastication. These protective factors have potential as therapeutic targets for GER. In this article, we aim to review diagnostic tools used to predict mucosal integrity, aging, and microbiome changes to the esophagus and esophageal mucosal defense mechanisms.
食管疾病，如胃食管反流（GER），可导致黏膜完整性、神经功能和微生物组发生变化。尽管了解甚少，但年龄和 GER 均可导致肠神经系统发生变化。此外，食管具有独特的微生物组，GER 可改变其微生物组。由于酸的持续损伤，黏膜完整性也存在风险。动态 pH/阻抗检测和食管黏膜阻抗等诊断工具可评估短期和纵向 GER 负担，也可评估黏膜损伤的风险。黏膜屏障的质量由细胞间空间、紧密连接和紧密连接蛋白决定，这些蛋白由闭合蛋白、紧密连接蛋白和黏附分子代表。幸运的是，食管黏膜下黏液腺和唾液中分泌的黏膜完整性保护因子通过咀嚼得到增强。这些保护因子有作为 GER 治疗靶点的潜力。本文旨在综述用于预测食管黏膜完整性、老化和微生物组变化以及食管黏膜防御机制的诊断工具。
