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 peristalsi...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.展开更多
AIM: To determine if the severity of gastroesophageal reflux disease is dependent on the size of a hiatus hernia. METHODS: Seventy-five patients with either a small(n = 25), medium(n = 25) or large(n = 25) hiatus hern...AIM: To determine if the severity of gastroesophageal reflux disease is dependent on the size of a hiatus hernia. METHODS: Seventy-five patients with either a small(n = 25), medium(n = 25) or large(n = 25) hiatus hernia(assessed by high resolution esophageal manometry) were investigated using 24-h esophageal monitoring and a self-assessed symptom questionnaire. The questionnaire comprised the following items, each graded from 0 to 3 according to severity: heartburn; pharyngeal burning sensation; acid regurgitation; and chest pain. RESULTS: The percentage total reflux time was significantly longer in the group with hernia of 5 cm or more compared with the group with a hernia of < 3 cm(P < 0.002), and the group with a hernia of 3 to < 5 cm(P < 0.04). Pharyngeal burning sensation, heartburn and acid regurgitation were more common with large hernias than small hernias, but the frequency of chest pain was similar in all three hernia groups. CONCLUSION: Patients with a large hiatus hernia are more prone to have pathological gastroesophageal reflux and to have more acid symptoms than patients with a small hiatus hernia. However, it is unlikely that patients with an absence of acid symptoms will have pathological reflux regardless of hernia size.展开更多
目的揭示2015年版《中国药典》中余甘子加热回流提取供试品制备过程中成分转化现象,研究其转化机制,提出新的供试品制备方法并进行提取工艺参数优化。方法采用高效液相指纹图谱对回流过程中余甘子中多种鞣质成分变化进行跟踪,并制备模...目的揭示2015年版《中国药典》中余甘子加热回流提取供试品制备过程中成分转化现象,研究其转化机制,提出新的供试品制备方法并进行提取工艺参数优化。方法采用高效液相指纹图谱对回流过程中余甘子中多种鞣质成分变化进行跟踪,并制备模型溶液揭示其转化机制,使用2015年版《中国药典》一部余甘子项下方法跟踪余甘子提取过程没食子酸含量变化,采用超声提取作为新的提取方法并进行方法学优化。结果指纹图谱结果显示,回流过程中诃黎勒酸、柯里拉京、没食子儿茶素等呈明显下降趋势,没食子酸、诃子次酸与鞣花酸则有明显上升趋势;模型溶液结果显示,在水解过程中,柯里拉京水解生成没食子酸和鞣花酸,而诃黎勒酸首先产生1分子柯里拉京和1分子的诃子次酸,柯里拉京则继续水解生成鞣花酸和没食子酸;药典回流提取法跟踪调查显示,随回流时间增加,没食子含量不断增加。超声提取的最佳优化结果为提取时间20min,提取功率300 W,溶媒用量30 m L,提取次数1次。结论余甘子加热回流过程中所含的水解鞣质如诃黎勒酸、柯里拉京等受热水解会导致所检测的没食子酸含量偏高,影响检测结果准确性,采用超声提取可抑制鞣质的水解,保证测定结果的准确性。展开更多
[目的]分析不同反流类型的难治性胃食管反流病(rGERD)患者情绪障碍特点。[方法]入选rGERD患者182例,所有患者行食管高分辨率测压以及24 h pH-阻抗监测检查,将其分为酸反流(AR)组106例、弱酸反流(WAR)组61例和非酸反流(NAR)组15例。并对...[目的]分析不同反流类型的难治性胃食管反流病(rGERD)患者情绪障碍特点。[方法]入选rGERD患者182例,所有患者行食管高分辨率测压以及24 h pH-阻抗监测检查,将其分为酸反流(AR)组106例、弱酸反流(WAR)组61例和非酸反流(NAR)组15例。并对各组患者进行HAMA、HAMD和GERD-HRQL量表评分。[结果](1)各组患者的性别、年龄、体质指数及GERD-HQRL比较均差异无统计学意义(P>0.05),但3组间病程比较差异有统计学意义(H=7.002,P=0.03),WAR组患者病程较短;(2)WAR组患者焦虑发生率与AR组和NAR组比较,均差异有统计学意义(χ^(2)=11.913,P=0.001;χ^(2)=12.270,P=0.005);(3)AR组与NAR组患者焦虑发生率比较差异无统计学意义(χ^(2)=0.272,P=0.602),而2组抑郁发生率比较差异有统计学意义(χ^(2)=6.121,P=0.013)。[结论]弱酸反流患者发生焦虑的可能性更大,病程相对较短;弱酸/非酸反流都可能是rGERD的发病机制,且易合并焦虑、抑郁。展开更多
文摘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.
文摘AIM: To determine if the severity of gastroesophageal reflux disease is dependent on the size of a hiatus hernia. METHODS: Seventy-five patients with either a small(n = 25), medium(n = 25) or large(n = 25) hiatus hernia(assessed by high resolution esophageal manometry) were investigated using 24-h esophageal monitoring and a self-assessed symptom questionnaire. The questionnaire comprised the following items, each graded from 0 to 3 according to severity: heartburn; pharyngeal burning sensation; acid regurgitation; and chest pain. RESULTS: The percentage total reflux time was significantly longer in the group with hernia of 5 cm or more compared with the group with a hernia of < 3 cm(P < 0.002), and the group with a hernia of 3 to < 5 cm(P < 0.04). Pharyngeal burning sensation, heartburn and acid regurgitation were more common with large hernias than small hernias, but the frequency of chest pain was similar in all three hernia groups. CONCLUSION: Patients with a large hiatus hernia are more prone to have pathological gastroesophageal reflux and to have more acid symptoms than patients with a small hiatus hernia. However, it is unlikely that patients with an absence of acid symptoms will have pathological reflux regardless of hernia size.
文摘目的揭示2015年版《中国药典》中余甘子加热回流提取供试品制备过程中成分转化现象,研究其转化机制,提出新的供试品制备方法并进行提取工艺参数优化。方法采用高效液相指纹图谱对回流过程中余甘子中多种鞣质成分变化进行跟踪,并制备模型溶液揭示其转化机制,使用2015年版《中国药典》一部余甘子项下方法跟踪余甘子提取过程没食子酸含量变化,采用超声提取作为新的提取方法并进行方法学优化。结果指纹图谱结果显示,回流过程中诃黎勒酸、柯里拉京、没食子儿茶素等呈明显下降趋势,没食子酸、诃子次酸与鞣花酸则有明显上升趋势;模型溶液结果显示,在水解过程中,柯里拉京水解生成没食子酸和鞣花酸,而诃黎勒酸首先产生1分子柯里拉京和1分子的诃子次酸,柯里拉京则继续水解生成鞣花酸和没食子酸;药典回流提取法跟踪调查显示,随回流时间增加,没食子含量不断增加。超声提取的最佳优化结果为提取时间20min,提取功率300 W,溶媒用量30 m L,提取次数1次。结论余甘子加热回流过程中所含的水解鞣质如诃黎勒酸、柯里拉京等受热水解会导致所检测的没食子酸含量偏高,影响检测结果准确性,采用超声提取可抑制鞣质的水解,保证测定结果的准确性。
文摘[目的]分析不同反流类型的难治性胃食管反流病(rGERD)患者情绪障碍特点。[方法]入选rGERD患者182例,所有患者行食管高分辨率测压以及24 h pH-阻抗监测检查,将其分为酸反流(AR)组106例、弱酸反流(WAR)组61例和非酸反流(NAR)组15例。并对各组患者进行HAMA、HAMD和GERD-HRQL量表评分。[结果](1)各组患者的性别、年龄、体质指数及GERD-HQRL比较均差异无统计学意义(P>0.05),但3组间病程比较差异有统计学意义(H=7.002,P=0.03),WAR组患者病程较短;(2)WAR组患者焦虑发生率与AR组和NAR组比较,均差异有统计学意义(χ^(2)=11.913,P=0.001;χ^(2)=12.270,P=0.005);(3)AR组与NAR组患者焦虑发生率比较差异无统计学意义(χ^(2)=0.272,P=0.602),而2组抑郁发生率比较差异有统计学意义(χ^(2)=6.121,P=0.013)。[结论]弱酸反流患者发生焦虑的可能性更大,病程相对较短;弱酸/非酸反流都可能是rGERD的发病机制,且易合并焦虑、抑郁。
