Chirurgia (Bucur). 2021 Oct;116(5):515-523. doi: 10.21614/chirurgia.116.5.515.
The pathophysiology of Gastroesophageal reflux disease (GERD) is multifactorial determined and remains a matter of discussions between the involved medical subspecialties, mainly gastroenterologists and gastrointestinal surgeons, but also ear-nose-and-throat colleagues and pulmonologists. The purpose of this manuscript is an overview on the different pathophysiologic components of GERD, their influence as well as a certain weighing of their involvement in the disease. The lower esophageal sphincter (LES) represents together with the muscles and ligamentous structures of the diaphragm at the esophageal hiatus the antireflux barrier between esophagus and stomach. The crucial factor in GERD is an increased amount of gastric contents refluxing into the esophagus above the physiologic level. This creates pathologic esophageal acid exposure (EAE) to the mucosa, which may lead to symptoms and damage. The underlying pathophysiologic mechanisms are anatomical components such as LES and diaphragm, and functional components such as LES-incompetence, transient LES relaxations, impaired esophageal motility, gastroduodenal dysfunctions and alterations of the refluxate such as duodeno-gastro-esophageal reflux. The quantitative assessment of these components has been reported in a number of studies demonstrating the importance of LES-incompetence (incidence 80 %) and the role of hiatal hernia (incidence 80 %) in the severity of GERD indicated by excessive esophageal acid exposure and visible damage of the esophageal mucosa. All known pathophysiologic components of GERD can be investigated currently by diagnostic assessment, detecting a LES-incompetence or an increase in transient relaxations, detecting a hiatal hernia with increasing size, detecting increasing exposure to gastric contents in addition to other possible functional associated disorders such as an insufficient esophageal motility and or a delayed gastric emptying, which all can aggravate the disease and the patient's status.
胃食管反流病（GERD）的病理生理学是多因素决定的，仍然是涉及医学亚专业的讨论主题，主要是胃肠病学家和胃肠外科医生，但也包括耳鼻喉科同事和肺病学家。本文的目的是概述 GERD 的不同病理生理成分、它们的影响以及它们在疾病中的一定权重。食管下括约肌（LES）与膈肌食管裂孔处的肌肉和韧带结构一起，构成食管和胃之间的抗反流屏障。GERD 的关键因素是胃内容物反流到食管超过生理水平的量增加。这会导致病理性食管酸暴露（EAE）到黏膜，从而导致症状和损伤。潜在的病理生理机制包括解剖学成分，如 LES 和膈肌，以及功能学成分，如 LES 功能不全、短暂性 LES 松弛、食管运动功能障碍、胃十二指肠功能障碍和反流物的改变，如十二指肠-胃-食管反流。这些成分的定量评估已在多项研究中报道，这些研究表明 LES 功能不全（发生率 80%）和食管裂孔疝（发生率 80%）在 GERD 严重程度中的重要性，其表现为食管酸暴露过度和食管黏膜可见损伤。目前可以通过诊断评估来研究 GERD 的所有已知病理生理成分，检测 LES 功能不全或短暂松弛增加，检测食管裂孔疝大小增加，检测胃内容物暴露增加，以及其他可能的相关功能障碍，如食管运动功能不足或胃排空延迟，所有这些都可能加重疾病和患者的病情。
