Behar J
J Clin Gastroenterol. 1986;8 Suppl 1:2-4. doi: 10.1097/00004836-198606001-00002.
Manometric measurements of the lower esophageal sphincter have shown that a decrease in resting pressures is the major factor in the pathogenesis of gastroesophageal reflux. About one-fourth of patients with reflux esophagitis, however, have LES pressures that overlap with those of controls, suggesting that other factors may also contribute to the development of reflux esophagitis. Among the additional factors that have been postulated as important are the esophageal acid clearance, the resistance of the esophageal squamous epithelium, the concentration of the causative agents (hydrochloric acid, pepsin, and bile salts), and perhaps the rates of gastric emptying. Nevertheless, in addition to the manometric data, there is a large body of evidence based on clinical, pathological, pharmacological, and therapeutic studies that strongly supports the concept that the lower esophageal tone is the required condition for all other secondary factors to play a role in the pathogenesis of reflux esophagitis.
食管下括约肌的测压结果表明，静息压力降低是胃食管反流发病机制中的主要因素。然而，约四分之一的反流性食管炎患者的食管下括约肌压力与对照组重叠，这表明其他因素也可能导致反流性食管炎的发生。在已被假定为重要的其他因素中，有食管酸清除能力、食管鳞状上皮的抵抗力、致病因子（盐酸、胃蛋白酶和胆盐）的浓度，或许还有胃排空速率。尽管如此，除了测压数据外，还有大量基于临床、病理、药理和治疗研究的证据，有力地支持了这样一种观点，即食管下段张力是所有其他次要因素在反流性食管炎发病机制中发挥作用的必要条件。
