难治性胃食管反流症状一定是胃食管反流病吗?

Refractory Gastroesophageal Reflux Symptoms Not Necessarily Denotes Gastroesophageal Reflux Disease

胃食管反流症状可由酸、非酸或弱酸等病理性反流所致,也可出现于食管高敏感、食管动力障碍、食管器质性疾病或解剖异常等情况。难治性胃食管反流病(GERD)是指经标准剂量质子泵抑制剂(PPI)治疗后症状仍不能缓解的GERD。大部分PPI治疗效果不佳的反流症状患者,其病因并非反流,而是由嗜酸粒细胞性食管炎、食管动力障碍、胃轻瘫或合并功能性胃肠病所致,对这类患者应详细了解病史,并行胃镜、病理检查以及食管pH/阻抗监测以明确其潜在病因。

The symptoms of gastroesophageal reflux may be induced by acid reflux,nonacidic or weakly acidic reflux,and also can occur with hypersensitive esophagus,esophageal motility disorders,or other organic/anatomical abnormalities of esophagus. Refractory gastroesophageal reflux disease（ GERD） denotes the symptoms of GERD could not be remitted with the standard dosage proton pump inhibitor（ PPI） therapy. In most patients with refractory symptoms the etiology is of non-reflux-related causes,such as eosinophilic esophagitis,esophageal motility disorders,gastroparesis,or concomitant functional gastrointestinal disorders. A careful and detailed understanding of patient’s medical history,examination with endoscopy and biopsy pathology,and esophageal pH-impedance monitoring are very important for identifying the potential cause.