Division of Gastroenterology, Duke University.
Duke Clinical Research Institute, Durham, North Carolina, USA.
Curr Opin Gastroenterol. 2024 Nov 1;40(6):442-448. doi: 10.1097/MOG.0000000000001059. Epub 2024 Aug 5.
This review describes pathologic conditions of retrograde flow into the esophagus along with recent therapeutic advances and treatment options.
The esophagus facilitates anterograde and retrograde movement of contents, the latter of which is mediated by transient lower esophageal sphincter relaxations (TLESRs). Gastroesophageal reflux disease (GERD) often includes esophageal-specific symptoms such as heartburn or regurgitation. Volume regurgitation responds less frequently to acid suppression with proton pump inhibitors (PPIs) than heartburn, given its relationship with incompetence of the esophagogastric junction (EGJ) and increased frequency of TLESRs. Therefore, although the refluxate pH can be altered with PPIs, the frequency of reflux episodes is generally not reduced and surgical and endoscopic treatments may be favored. Other instances of abnormal retrograde esophageal flow respond better to medical therapy, or lifestyle interventions. Compared to gastric belching because of increased stomach distension, supragastric belching is caused by intake of air from pharynx into the esophagus followed by rapid expulsion of air. These conditions can be distinguished on esophageal tests such as high-resolution manometry and are likely to respond to behavioral modifications.
Retrograde flow into the esophagus can be a normal occurrence, but diagnostic testing to distinguish causes can guide appropriate intervention.
本文描述了食管内逆行回流的病理状况，并介绍了最近的治疗进展和治疗选择。
食管促进内容物的顺行和逆行运动，后者由短暂的食管下括约肌松弛（TLESR）介导。胃食管反流病（GERD）常包括食管特异性症状，如烧心或反流。与烧心相比，容量反流对质子泵抑制剂（PPIs）的抑酸反应较差，因为其与食管胃连接（EGJ）功能不全和 TLESR 频率增加有关。因此，尽管 PPI 可以改变反流物的 pH 值，但反流发作的频率通常不会降低，可能更倾向于手术和内镜治疗。其他异常食管逆行流的情况对药物治疗或生活方式干预的反应更好。与因胃膨胀而引起的胃嗳气相比，胃上嗳气是由于咽部空气进入食管，然后迅速排出空气引起的。这些情况可以通过高分辨率测压等食管检查来区分，并可能对行为改变有反应。
食管内逆行回流可能是正常现象，但通过诊断测试来区分病因可以指导适当的干预。
