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基于罗马Ⅳ分类的食管反流高敏感疾病研究进展
Research advances in esophageal reflux hypersensitivity based on ROME Ⅳ criteria
【摘要】 罗马Ⅳ介绍了一种新的功能性食管疾病——反流高敏感。反流高敏感患者存在典型的烧心症状,其内镜及病理活检正常,p H监测或阻抗-p H监测正常,但存在反流事件诱发症状的依据。反流高敏感患者临床表现与胃食管反流病及功能性烧心相似,需行内镜检查、食管反流监测及高分辨食管测压以明确诊断。反流监测酸暴露正常,症状指数(symptom index,SI)或症状相关概率(symptom association probability,SAP)对反流高敏感而言具有诊断意义。食管测压可除外主要食管动力障碍。反流高敏感的病理生理机制主要为周围和中枢神经敏化作用导致的食管高敏感,如细胞间隙增加、酸敏感受体上调、伤害感受器转换阈值降低、N-甲基-D天冬氨酸受体磷酸化,以及精神心理异常等。反流高敏感患者治疗主要包括抗反流治疗及疼痛调节治疗,除传统治疗外,前列腺素EP1受体拮抗剂ONO-8539可改善酸诱发的烧心症状。
【Abstract】 ROME Ⅳ introduces reflux hypersensitivity as a new functional esophageal disorder. The patients with reflux hypersensitivity presence have typical heartburn symptoms but are with normal endoscopy and esophageal biopsies, normal esophageal p H monitoring or impedance-p H monitoring and with a close correlation between symptom and reflux events. Reflux hypersensitivity patients’ symptoms are similar to those of gastro-esophageal reflux disease or functional heartburn. Diagnosis is depended on endoscopy, esophageal reflux monitoring and high-resolution esophageal manometry. Symptom index or symptom association probability positive with normal acid exposure on reflux monitoring meets diagnostic criteria for reflux hypersensitivity. Esophageal manometry is needed to exclude major esophageal motor disorders. Pathophysiologic mechanisms underlying reflux hypersensitivity include peripheral and/or central sensitization and psychological abnormalities. Peripheral and central sensitization includes dilated intercellular spaces, upregulation of acid sensing receptor, reduction of nociceptor transduction threshold and phosphorylation of NMDA receptor. Reflux hypersensitivity is primarily treated with anti-reflux therapy and pain modulators. Besides traditional therapies, prostanoid EP1 receptor antagonist, ONO-8539, reduces acid-induced heartburn symptoms.
【Key words】 reflux hypersensitivity; gastro-esophageal reflux disease; impedance-pH monitoring; high-resolution manometry;
- 【文献出处】 中国实用内科杂志 ,Chinese Journal of Practical Internal Medicine , 编辑部邮箱 ,2018年09期
- 【分类号】R571
- 【被引频次】10
- 【下载频次】340