Paterson W G
Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario.
Can J Gastroenterol. 1997 Sep;11 Suppl B:45B-50B.
With the widespread availability of ambulatory esophageal pH monitoring, there has been recently renewed interest in the so-called 'extraesophageal' complications of gastroesophageal reflux disease (GERD). There are two proposed mechanisms by which reflux can cause extraesophageal symptoms or disease: refluxed acid may reach the oropharynx and/or respiratory tract and cause direct irritation; or acid contact with the esophageal mucosa may trigger neural reflexes, which, in turn, produce symptoms. Evidence is most compelling for an association between GERD and unexplained dental erosions, posterior laryngitis, chronic unexplained cough and intrinsic asthma. The clinician should be aware of these associations, and patients with these conditions should be questioned carefully about associated GERD symptoms. When GERD and any of these conditions coexist, intensive medical antireflux therapy is indicated. Twenty-four hour pH monitoring may be required in selected patients to document the relationship between reflux and the extraesophageal complication or to ensure that the medical therapy provided has eliminated acid reflux.
随着动态食管pH监测的广泛应用，近来人们对胃食管反流病（GERD）的所谓“食管外”并发症重新产生了兴趣。反流导致食管外症状或疾病有两种可能机制：反流的酸可能到达口咽和/或呼吸道并引起直接刺激；或者酸与食管黏膜接触可能触发神经反射，进而产生症状。GERD与不明原因的牙齿侵蚀、喉后部炎症、慢性不明原因咳嗽和内源性哮喘之间存在关联，这一证据最为确凿。临床医生应了解这些关联，对于患有这些疾病的患者，应仔细询问其是否有相关的GERD症状。当GERD与上述任何一种疾病共存时，应进行强化抗反流药物治疗。对于部分患者，可能需要进行24小时pH监测，以记录反流与食管外并发症之间的关系，或确保所提供的药物治疗已消除酸反流。
