胃食管反流病合并情绪障碍的研究现状与诊治策略

Research status and diagnosis and treatment strategies of gastroesophageal reflux disease with emotional disorders

胃食管反流病(gastroesophageal reflux disease,GERD)是临床常见的消化系统疾病,机制复杂,情绪障碍在GERD的发生、发展及转归中起到了重要作用,其相互影响的可能机制为:应激导致的脑肠互动异常;情绪障碍可引起某些促炎因子释放及5-HT信号通路紊乱,加重食管免疫炎症及动力异常;迷走神经功能紊乱;食管内脏高敏感;食管及肠道菌群异常。情绪障碍可促进GERD与功能性胃肠病症状重叠,影响GERD药物及抗反流手术的治疗效果。其治疗策略包括:建立互信的医患关系、进行必要的心理干预,重症难治者可使用神经递质药。另外,中医药通过辨证论治,对于治疗该类患者显示出明显优势,未来建立GERD中西医结合防治体系意义重大。

Gastroesophageal reflux disease(GERD) is a common digestive system disease in clinical practice, with complex mechanisms. Studies have shown that emotional disorders may play a vital role in the occurrence, development, and prognosis of GERD. Several evidence have shown the possible mutual mechanisms, which involve the abnormal brain gut interaction caused by stress, the release of certain pro-inflammatory factors and disruption of the 5-HT signaling pathway caused by emotional disorders, exacerbating esophageal immune inflammation and abnormal motility, the vagal nerve dysfunction, the esophageal visceral hypersensitivity, and the abnormal esophageal and intestinal microbiota. Emotional disorders can promote the overlap of GERD and functional gastrointestinal disease symptoms, affecting the therapeutic effect of GERD drugs and anti-reflux surgery. The treatment strategies include establishing a mutual trust doctor-patient relationship, providing necessary psychological intervention, and using neurotransmitter drugs for severe and difficult-to-treat patients. In addition, Traditional Chinese Medicine has shown significant advantages in treating such patients through syndrome differentiation and treatment. It is of great significance to establish a comprehensive prevention and treatment system of Traditional Chinese and Western Medicine in the future.