从心身角度认识胃食管反流病

The cognition of gastroesophageal reflux disease from the perspective of psychosomatic factors

胃食管反流病(GERD)为一组疾病症候群,包括典型症状如反酸和烧心,以及不典型症状如胸痛、嗳气,还有食管外症状如咳嗽、哮喘等。其定义不断进行更新,最新定义为胃内容物反流入食管或口腔、咽喉、肺部引起的症状和并发症。GERD发病机制包括滑动性食管裂孔疝、一过性食管下括约肌松弛、酸囊、食管清除能力下降、胃排空延迟、十二指肠胃食管反流等。焦虑、抑郁等心理因素可导致食管的敏感性增高,而后者可产生GERD相关症状。心理应激对食管敏感性的影响主要通过外周及中枢机制,即外周致敏和中枢致敏,而后者起主要作用。对GERD患者的治疗中应根据每位患者的具体情况采取个体化原则,应重视心理因素。

The definition of gastroesophageal reflux disease （ GERD ） continues to be updated. GERD is now defined as symptoms or complications resulted from the reflux of gastric contents into the esophagus or beyond,into the oral cavity （ including larynx） or lung.GERD is a group of disease syndrome, includes typical symptoms such as acid reflux and heartburn, and atypical symptoms such as chest pain, belching,and extra esophageal symptoms such as cough and asthma.The pathogenesis of GERD includes sliding hiatal hernia, transient lower esophageal sphincter relaxation, acid pocket, decreased ability of esophageal clearance, delayed gastric emptying, duodenogastro-esophageal reflux and so on, anxiety, depression and other stress factors which can lead to increased esophageal sensitivity, which can produce GERD-related symptoms.The effect of stress on esophageal sensitivity is mainly through the peripheral and central mechanisms,namely peripheral sensitization and central sensitization,the latter plays a major role.We should take the principle of individual on the treatment of GERD patients according to the specific circumstances of each patient,while psychological factors should receive attention.