Correlation of acid reflux and esophageal motility in patients with gastroesophageal reflux disease

Objective:To explore the relationship between acid reflux and esophageal motility in patients with gastroesophageal reflux disease.Methods:From January 2018 to December 2019,80 patients with typical gastroesophageal reflux symptoms such as reflux and heartburn were randomly selected from the Department of Gastroenterology,First Affiliated Hospital of guangxi university of chinese medicine.The patients were divided into pathological group,sensitive group and physiological group based on the percentage of acid exposure time and reflux-symptom correlation.The GerdQ score,quality of life score,esophageal acid test and esophageal manometry related parameters of the three groups of patients were compared.Results:Compared with the sensitive group and the physiological group,the GerdQ score,DeMeester score,orthostatic acid reflux time,orthostatic acid reflux time,longest acid reflux time and acid reflux times in the pathological group were significantly higher.Sf-36 score,lower esophageal sphincter pressure and effective rate of deglutition were all significantly reduced,with statistically significant differences(P<0.05).Compared with the physiological group,the GerdQ score of the sensitive group was higher.The sf-36 score was low,and the differences were statistically significant(P<0.05).The acid indexes in the sensitive group were higher than those in the physiological group,but the differences were not statistically significant(P>0.05).Compared with the physiological group,the distal contraction integral and the amplitude of the lower esophageal sphincter 3cm above the pathological group and the sensitive group decreased significantly(P<0.05).There were no statistically significant differences in the length of the lower esophageal sphincter,the length of the lower esophageal sphincter in the abdominal segment,the amplitude of the upper esophageal sphincter at 7cm and 11cm and the peristaltic wave velocity of the esophageal body in the three groups(P>0.05).Conclusion:the decrease of lower esophageal sphincter pressure is the key factor leading to pathological acid reflux,and acid reflux is closely related to distal contraction integral and peristaltic amplitude of 3cm on lower esophageal sphincter in patients with gastroesophageal reflux disease.

Characteristics of Acid Reflux in Barrett's Esophagus

To determine the relationship between Barrett'sesophagus (BE) and features of ga stroesophageal acid reflux, 24 h esophageal pH monitoring was performed in 90 pa tients. The patients were divided into 3 groups: 31 subjects with BE, 21 with mi ld esophagitis and 38 with severe esophagitis. The following parameters were eva luated: the percentage time of pH<4; the number of reflux episodes over 5 min; t he duration of longest episodes and DeMeester score over total period and the au terior three parameters in erect and supine position . All these parameters in BE were significantly different from those with mild e sophagitis ( P <0.01) and not significantly different from those with severe esophagitis ( P >0.05). During supine position all the above parameters in BE were significantly different from those with reflux esophagitis ( P <0.05). It is concluded that the quantity of acid reflux is not an important factor in development of BE in gastroesophageal reflux (GER), and the acid reflux in supine position might be important in development of BE in GER.

Anti-apoptotic effect of banhasasim-tang on chronic acid reflux esophagitis

AIM To evaluate the anti-apoptotic effect of banhasasimtang(BHSST) on chronic acid reflux esophagitis(CARE) using a rat model.METHODS A surgically-induced CARE model was established in Sprague-Dawley rats. The modeled rats were divided into a treatment group or untreated group, and given BHSST(1 g/kg body weight per day) or water, respectively, for 15 consecutive days(n = 7 each group). Changes in expression of proteins related to nicotinamide adenine dinucleotide phosphate(NADPH) oxidase and apoptosis were assessed by western blotting. Changes in esophageal pathology were analyzed by gross and histological examinations.RESULTS The CARE exposure modeled rats showed increased levels of the NADPH oxidase subunit, NOX4 and p47 phox in the esophagus. The BHSST treatment completely resolved these CARE-related increases. The CARE rats also showed markers of cytokine stress, including elevated levels of TNF-α and reactive oxygen species as well as of the consequent increase in JNK activation, and subsequent decrease in pro-survival gene expression, such as of Bcl-2. BHSST treatment resolved the CARE-related changes. BHSST also exerted an antiapoptotic effect, as evidenced by altered expression of the apoptosis-related genes for bax, cytochrome c,and caspase 3. Finally, the BHSST treatment markedly ameliorated the CARE-related esophageal mucosal ulcerations. CONCLUSION In the rat model of CARE, BHSST can suppress development of esophageal mucosal ulceration via regulation of reactive oxygen species-dependent apoptosis.

Acid and non-acid reflux in patients refractory to proton pump inhibitor therapy:Is gastroparesis a factor?

AIM:To determine whether an increased number and duration of non-acid reflux events as measured using the multichannel intraluminal impedance pH(MII-pH)is linked to gastroparesis(GP).METHODS:A case control study was conducted in which 42 patients undergoing clinical evaluation for continued symptoms of gastroesophageal reflux disease(both typical and atypical symptoms)despite acid suppression therapy.MII-pH technology was used over 24 h to detect reflux episodes and record patients’symptoms.Parameters evaluated in patients with documented GP and controls without GP by scintigraphy included total,upright,and supine number of acid and non-acid reflux episodes(pH<4 and pH>4,respectively),the duration of acid and non-acid reflux in a 24-h period,and the number of reflux episodes lasting longer than 5 min.RESULTS:No statistical difference was seen between the patients with GP and controls with respect to the total number or duration of acid reflux events,total number and duration of non-acid reflux events or the duration of longest reflux episodes.The number of nonacid reflux episodes with a pH>7 was higher in subjects with GP than in controls.In addition,acid reflux episodes were more prolonged(lasting longer than 5min)in the GP patients than in controls;however,these values did not reach statistical significance.Thirty-five patients had recorded symptoms during the 24 h study and of the 35 subjects,only 9%(n=3)had a positive symptom association probability(SAP)for acid/non-acid reflux and 91%had a negative SAP.CONCLUSION:The evaluation of patients with a documented history of GP did not show an association between GP and more frequent episodes of non-acid reflux based on MII-pH testing.

Prolapse gastropathy syndrome may be a predictor of pathologic acid reflux

AIM: To assess the occurrence of gastric acid reflux into the esophagus in endoscopically confirmed prolapse gastropathy syndrome (PGS). METHODS: Using ambulatory esophageal pH measurement (BRAVOTM wireless esophageal pH monitoring system), twenty-six patients with PGS were compared with twenty-one patients with erosive esophagitis (EE) as controls. We assessed several reflux parameters, including the percentage of total time at pH < 4, and the DeMeester score. RESULTS: There were no statistical differences between the PGS group and the EE group as to mean age, sex ratio and pH recording time. The EE group showed more severe reflux than the PGS group, as evaluated in terms of the longest duration of reflux, the number of reflux episodes, the number of reflux episodes lasting > 5 min, the total time with pH < 4 during acid reflux episodes, and the DeMeester score, but none of these parameters showed statistically significant difference. Although 53.8% (14/26) ofthe PGS group and 76.2% (16/21) of the EE group demonstrated pathologic acid reflux (DeMeester score > 14.72), there was no statistically significant difference between the two groups in the incidence of pathologic acid reflux (P = 0.11). CONCLUSION: There was no statistically significant difference in pathologic acid reflux between the PGS and EE group. These data suggest that endoscopically diagnosed PGS might be a predictor of pathologic acid reflux.

Study on Optimization of Ethanol Reflux Extraction of Phenolic Acids from Salvia miltiorrhiza

The extraction technology of phenolic acid compounds from Salvia miltiorrhiza by ethanol reflux was studied. In this experiment, salvianolic acid B standard was used to make the standard curve. Single factor experiment and orthogonal experiment were used to study the extraction of different ethanol concentrations, reflux times and material-to-liquid ratios. The OD value of salvianolic acid compounds was measured with a spectrophotometer. The extraction rate of phenolic acid compounds under different extraction conditions was calculated through a regression equation, so as to obtain the optimal conditions for the ethanol reflux extraction process of Salvia miltiorrhiza. The experimental data can provide a reference for the ethanol reflux extraction process of salvianolic acids in the industry. According to the experiment, the extraction rate of phenolic acids in Salvia miltiorrhiza was the highest when the ethanol concentration was 60%, the reflux time was 1.5 hours, and the ratio of material-to-liquid was 1:10.

Prospective,randomized,and active controlled study of the efficacy of alginic acid and antacid in the treatment of patients with endoscopy-negative reflux disease

瞄准：与内视镜检查法否定的倒流疾病(ENRD ) 在病人与相等力量的解酸药(Nacid ) 相比加解酸药(Topaal ) 估计复合包含藻酸的功效和安全。方法：有 ENRD 的 121 个病人的一个总数被使随机化收到 Topaal (65 个病人) 或 Nacid (56 个病人) 6 个星期，与咨询每 3 个星期。主要端点评价是在在 6 个星期用视觉模拟规模(管) 评估了的心痛的严厉的变化。第二等的端点评价是在 3 个星期的 VAS，倒流症状的频率的变化，生命和不利效果的质量的变化。结果：除了 Topaal 组包括了更多的男性之外，在每个治疗组的使随机化的题目的人口分布是可比较的。在这些组之间的基线特征是类似的。在 6 星期治疗以后，心痛的管的减小在 Topaal 组(-6.29 厘米对 -4.11 厘米) 是更突出的。在第三个星期， Topaal 为心痛(P=0.0016 ) 组织管的显示出的更大的减小，流回(P=0.0006 ) ，呕吐(P=0.0373 ) ，并且打嗝(P【0.0001 ) 。Topaal 组的病人在 6 星期的治疗经期的结束有心痛(P=0.0015 ) 和疼痛(P=0.0163 ) 的低频率。从医生的观点， Topaal 组也在心痛(P=0.0020 ) 的严厉显示出重要减小，流回(P=0.0081 ) ，呕吐(P=0.0182 ) ，并且打嗝(P=0.0018 ) 在治疗的结束。生命的质量的改进在在 6 星期的治疗经期(P【0.0001 ) 的结束的 Topaal 组是更显著的。为不利效果，在两个没有差别这些组。结论：Topaal 是比为病人与 ENRD 介绍的症状的治疗的 Nacid 更有效的。

Comparative evaluation of intragastric bile acids and hepatobiliary scintigraphy in the diagnosis of duodenogastric reflux

AIM:To assess the diagnostic value of a combination of intragastric bile acids and hepatobiliary scintigraphy in the detection of duodenogastric reflux(DGR).METHODS:The study contained 99 patients with DGR and 70 healthy volunteers who made up the control group.The diagnosis was based on the combination of several objective arguments:a long history of gastric symptoms(i.e.,nausea,epigastric pain,and/or bilious vomiting) poorly responsive to medical treatment,gastroesophageal reflux symptoms unresponsive to protonpump inhibitors,gastritis on upper gastrointestinal(GI) endoscopy and/or at histology,presence of a bilious gastric lake at > 1 upper GI endoscopy,pathologic 24-h intragastric bile monitoring with the Bilitec device.Gas-tric juice was aspirated in the GI endoscopy and total bile acid(TBA),total bilirubin(TBIL) and direct bilirubin(DBIL) were tested in the clinical laboratory.Continuous data of gastric juice were compared between each group using the independent-samples Mann-Whitney U-test and their relationship was analysed by Spearman's rank correlation test and Fisher's linear discriminant analysis.Histopathology of DGR patients and 23 patients with chronic atrophic gastritis was compared by clinical pathologists.Using the Independent-samples Mann-Whitney U-test,DGR index(DGRi) was calculated in 28 patients of DGR group and 19 persons of control group who were subjected to hepatobiliary scintigraphy.Receiver operating characteristic curve was made to determine the sensitivity and specificity of these two methods in the diagnosis of DGR.RESULTS:The group of patients with DGR showed a statistically higher prevalence of epigastric pain in comparison with control group.There was no significant difference between the histology of gastric mucosa with atrophic gastritis and duodenogastric reflux.The bile acid levels of DGR patients were significantly higher than the control values(Z:TBA:-8.916,DBIL:-3.914,TBIL:-6.197,all P < 0.001).Two of three in the DGR group have a significantly associated with each other(r:TBA/DBIL:0.362,TBA/TBIL:0.470,DBIL/TBIL:0.737,all P < 0.001).The Fisher's discriminant function is followed:Con:Y = 0.002TBA + 0.048DBIL + 0.032TBIL 0.986;Reflux:Y = 0.012TBA + 0.076DBIL + 0.089TBIL-2.614.Eighty-four point zero five percent of original grouped cases were correctly classified by this method.With respect to the DGR group,DGRi were higher than those in the control group with statistically significant differences(Z =-5.224,P < 0.001).Twenty eight patients(59.6%) were deemed to be duodenogastric reflux positive by endoscopy,as compared to 37 patients(78.7%) by hepatobiliary scintigraphy.CONCLUSION:The integrated use of intragastric bile acid examination and scintigraphy can greatly improve the sensitivity and specificity of the diagnosis of DGR.

Outcome of nonerosive gastro-esophageal reflux disease patients with pathological acid exposure

AIM: To assess the management and outcome of nonerosive gastro-esophageal reflux disease (NERD) patients who were identified retrospectively, after a 5-year follow-up.METHODS: We included patients with gastro-esophageal reflux disease (GERD) symptoms who had a negative endoscopy result and pathological 24-h esophageal pH-monitoring while off therapy. We interviewed them after an average period of 5 years (range 3.5-7 years) by means of a structured questionnaire to assess presence of GERD symptoms, related therapy, updated en-doscopic data and other features. We assessed predictors of esophagitis development by means of univariate and multivariate statistical analysis.RESULTS: 260 patients (137 women) were included. Predominant GERD symptoms were heartburn andregurgitation in 103/260 (40%). 70% received a maintenance treatment, which was proton pump inhibitor (PPI) in 55% of cases. An average number of 1.5 symptomatic relapses per patient/year of follow-up were observed. A progression to erosive gastro-esophageal reflux disease (ERD) was found in 58/193 (30.0%) of patients undergoing repeat endoscopy; 72% of these were Los Angeles grade A-B. CONCLUSION: This study shows that progression to ERD occurs in about 5% of NERD cases per year, despite therapy. Only two factors consistently and independently influence progression: smoking and absence of PPI therapy.

熊去氧胆酸联合常规西医治疗胆汁反流性胃炎合并幽门螺旋杆菌感染的疗效及对IL-8、PGE2的影响

目的探讨熊去氧胆酸联合常规西医治疗胆汁反流性胃炎(BRG)合并幽门螺旋杆菌(Hp)感染的疗效及对白细胞介素-8(IL-8)、PGE2(前列腺素E2)的影响。方法选取2019年5月—2021年5月巴彦淖尔市医院收治的100例Hp呼吸试验为阳性的BRG患者进行研究,应用随机数表法将其分为观察组与对照组,每组50例。对照组采取常规西医治疗(克拉霉素+奥美拉唑+阿莫西林),观察组在常规西医治疗基础上增加熊去氧胆酸素治疗,对比两组患者临床疗效,并应用酶联免疫吸附法检测治疗前后血清白细胞介素-8(IL-8)、PGE2(前列腺素E2)表达水平,对比胃泌素(GAS)、胃动素(MTL)、胆囊收缩素(CCK)表达水平以及不良反应情况。结果观察组治疗总有效率明显高于对照组,差异有统计学意义(P<0.05);治疗后两组患者血清IL-8水平降低,观察组低于对照组,PGE2水平升高,观察组高于对照组(P<0.05);治疗后两组患者血清CCK水平降低,观察组低于对照组,MTL、GAS水平升高,观察组高于对照组,差异有统计学意义(P<0.05);两组患者均无严重不良反应发生,且轻度不良反应比较,差异无统计学意义(P>0.05),但观察组Hp根除率高于对照组(P<0.05)。结论对胆汁反流性胃炎合并Hp感染患者在常规西医治疗的基础上增加熊去氧胆酸能够提升其临床疗效,降低患者炎症反应,提升胃动力,调节胃肠激素,提升Hp根除率,且安全性较高。

Impact of gastroesophageal reflux control through tailored proton pump inhibition therapy or fundoplication in patients with Barrett's esophagus

AIM To determine the impact of upwards titration of proton pump inhibition(PPI) on acid reflux, symptom scores and histology, compared to clinically successful fundoplication.METHODS Two cohorts of long-segment Barrett's esophagus(BE) patients were studied. In group 1(n = 24), increasing doses of PPI were administered in 8-wk intervals until acid reflux normalization. At each assessment, ambulatory 24 h p H recording, endoscopy with biopsies and symptom scoring(by a gastroesophageal reflux disease health related quality of life questionnaire, GERD/HRLQ) were performed. Group 2(n = 30) consisted of patients with a previous fundoplication. RESULTS In group 1, acid reflux normalized in 23 of 24 patients, resulting in improved GERD/HRQL scores(P = 0.001), which were most pronounced after the starting dose of PPI(P < 0.001). PPI treatment reached the same level of GERD/HRQL scores as after a clinically successful fundoplication(P = 0.5). Normalization of acid reflux in both groups was associated with reduction in papillary length, basal cell layer thickness, intercellular space dilatation, and acute and chronic inflammation of squamous epithelium. CONCLUSION This study shows that acid reflux and symptom scores co-vary throughout PPI increments in long-segment BE patients, especially after the first dose of PPI, reaching the same level as after a successful fundoplication. Minor changes were found among GERD markers at the morphological level.

胆汁反流发病机制与诊断及治疗研究进展

胆汁反流是由于胆汁逆行运动到胃及其以上部位,长期的胆汁反流除了引起胆汁反流性胃炎外,还可导致肠化、Barrett食管,甚至是胃癌、食管癌、咽喉癌的高危因素。长期频繁的胆汁反流应视为病理性胆汁反流,胆汁反流分为原发性反流和继发性反流。临床上胆汁反流常见的症状包括腹胀、口苦、上腹痛、恶心呕吐等。原发性胆汁反流无胃手术即可发生,而继发性胆汁反流通常在胃肠手术后发生。本文对胆汁反流发病机制与诊断和治疗进展进行综述。

喻斌教授治疗反流性食管炎并焦虑抑郁经验

目的 探析喻斌教授以半夏厚朴汤合左金丸论治反流性食管炎合并焦虑抑郁的临证思路与用药经验。方法 通过跟师,收集整理全程医案,查阅相关文献,总结喻教授治疗反流性食管炎的理论思想,治法特色,用药经验,并附有临床医案。结果 喻斌教授认为,应从气、痰、火3个病理因素论治反流性食管炎。根据反流性食管炎最典型症状,喻教授治疗此病首取理气化痰,舒咽喉,畅情志;次以疏肝泻火,调和胃络止痛。结论 喻教授治疗反流性食管炎的经验丰富,独具特色,值得临床推广应用。

谢晶日教授治疗胃食管反流病经验

胃食管反流病是我国高发疾病,是中医治疗的优势病种。本文从“诸呕吐酸,皆属于热”提炼出本病的病机以郁、酸、热、逆为主的病机特点,旨在总结谢晶日教授对胃食管反流病病因病机的认识和临床治疗特点。提出本病的发生与情志密切相关,治疗从肝胃出发,主要采用疏肝解郁、调和肝胃以泄郁热制酸,和胃降逆、通腑降气以畅中焦气机的治疗方法。在治疗的同时,谢晶日注重身心调养。其疗效确切,以资借鉴。

郭天禄从水血互病探讨旋覆代赭汤治疗难治性反流性食管炎机制

难治性反流性食管炎为胃食管反流病的一种,病情反复,迁延难愈。旋覆代赭汤为中医治疗该病的首选方剂。目前,对于旋覆代赭汤的认识多局限于和胃降逆、化痰下气。此文通过梳理历代医家对此方的认识,结合临床实践,宗仲景“血不利则为水”之旨,从“水血互病”角度阐释旋覆代赭汤对难治性反流性食管炎的治疗机制,进一步提高中医临床运用该方治疗难治性反流性食管炎的效果。

蒌贝二陈汤治疗胃癌术后胃食管反流病临床观察

目的观察蒌贝二陈汤治疗胃癌术后胃食管反流病的临床效果。方法选择胃癌术后胃食管反流病患者100例,随机分为观察组和对照组,各50例。对照组采用常规治疗,观察组采用蒌贝二陈汤治疗。比较2组患者的临床效果,胸骨后疼痛、烧心、反酸、胃胀、嗳气等症状评分以及随访治愈情况。结果治疗后,观察组总有效率为94.0%(47/50),高于对照组的70.0%(35/50)(P<0.05);观察组的胸骨后疼痛、烧心、反酸、胃胀、嗳气等症状评分均明显低于对照组(P<0.05);治疗结束3个月后,随访2组患者治愈情况,观察组治愈率为80.0%(40/50),高于对照组的50.0%(25/50)(P<0.05)。结论蒌贝二陈汤能够显著改善胃癌术后胃食管反流病患者的临床症状,疗效显著。

Mechanism of Wumei Pill in the Treatment of Non-Erosive reflux disease from the Perspective of Network Pharmacology and Molecular docking

Objective:Based on network pharmacology and molecular docking to explore the mechanism of Wumei Pill in the treatment of non-erosive reflux disease(NERD).Method:We collected the active ingredients and targets of Wumei Pill by Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP),and collected NERD related targets through Genecards,PharmGKB,Drugbank,DisGeNET,OMIM,CTD and TTD databases.Intersection targets of Wumei Pill targets and NERD related targets were the potential targets of Wumei Pill in the treatment of NERD.We imported the intersection targets into the STRING database to obtain the PPI network,and obtained the hub targets.The network diagram of"Drugs-Potential active ingredients-Potential targets"was constructed by Cytoscape 3.7.2 software.We used R software to perform Gene Ontology function enrichment analysis(GO)and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis(KEGG)on hub targets,and then performed molecular docking verification.Results:There were 129 active ingredients and 213 drug targets of Wumei Pill of which 114 were the intersection targets.1587 GO enrichment items were identified(P<0.05),including 1,491 biological processes,11 cell components,and 85 molecular functions.143 KEGG pathways(P<0.05),mainly related to Kaposi sarcoma-associated herpesvirus infection,IL-17 signaling pathway,the TNF signaling pathway,MAPK signaling pathway.Results of molecular docking showed that the potential active ingredients in Wumei Pill had relatively stable binding activity to the key targets.Conclusion:Wumei pill for the treatment of non-erosive reflux disease are main active ingredients quercetin,kaempferol,beta sitosterol,Isocorypalmine,Stigmasterol,rutaecarpine,etc,the main targets is JUN,TP53,AKT1,may inhibit excessive inflammation,antioxidant therapy effect into full play.This provided a certain theoretical basis for clinical application.

不同抑酸剂治疗Hp感染伴反流性食管炎的临床疗效分析

目的 比较伏诺拉生四联疗法与传统的雷贝拉唑四联疗法治疗幽门螺杆菌(Helicobacter pylori, Hp)感染伴反流性食管炎(reflux esophagitis, RE)患者的临床疗效及安全性。方法 回顾性分析2023-01~10月在作者单位就诊的265例Hp感染伴RE患者的临床资料。根据治疗方案分为伏诺拉生组(n=102)和雷贝拉唑组(n=163)。比较两组患者的临床基线资料,分析治疗后的Hp根除率,记录胃食管反流病量表(gastroesophageal reflux disease questionnaire, GerdQ)评分,比较临床疗效,并观察不良反应发生情况。结果 两组Hp感染伴RE患者临床基线资料比较差异无统计学意义(P>0.05)。伏诺拉生组患者的Hp根除率显著高于雷贝拉唑组(P<0.05);治疗6周后,伏诺拉生组患者的GerdQ评分明显低于雷贝拉唑组,治疗总有效率显著高于雷贝拉唑组(P均<0.05)。两组Hp感染伴RE患者不良反应发生率比较差异无统计学意义(P>0.05)。结论 伏诺拉生四联疗法可显著提高Hp感染伴RE患者的Hp根除率和RE临床疗效,是一种值得推荐的安全有效治疗方案。

柴胡疏肝散合左金丸治疗肝胃郁热型难治性胃食管反流病临床研究

目的观察柴胡疏肝散合左金丸治疗难治性胃食管反流病(RGERD)(肝胃郁热型)的临床疗效。方法将112例符合标准的患者随机分为治疗组及对照组各56例,对照组予雷贝拉唑及莫沙必利,治疗组在对照组基础上加服柴胡疏肝散合左金丸。治疗8周后,观察2组患者的症状、内镜下食管炎症、Gerd⁃Q积分、SAS评分、SDS评分、GAS的变化及治疗期间不良反应发生情况。结果治疗组总有效率优于对照组,差异有统计学意义(P<0.05)。治疗后,2组中医证候、内镜下食管黏膜炎症、Gerd⁃Q、SAS评分、SDS评分均比治疗前降低(P<0.05),2组GAS水平均上升(P<0.05),治疗组更显著(P<0.05)。2组患者均未见明显不良反应。结论柴胡疏肝散合左金丸治疗肝胃郁热型RGERD疗效显著,安全性良好。

Gastroesophageal reflux disease:From pathophysiology to treatment

This review focuses on the pathophysiology of gastroesophageal reflux disease (GERD) and its implications for treatment. The role of the natural anti-reflux mechanism (lower esophageal sphincter, esophageal peristalsis, diaphragm, and trans-diaphragmatic pressure gradient), mucosal damage, type of refluxate, presence and size of hiatal hernia, Helicobacter pylori infection, and Barrett’s esophagus are reviewed. The conclusions drawn from this review are: (1) the pathophysiology of GERD is multifactorial; (2) because of the pathophysiology of the disease, surgical therapy for GERD is the most appropriate treatment; and (3) the genesis of esophageal adenocarcinoma is associated with GERD.