The pathogenesis of heartburn in nonerosive reflux disease: A unifying hypothesis

被引:195
作者
Barlow, WJ [1 ]
Orlando, RC [1 ]
机构
[1] Tulane Univ, Hlth Sci Ctr, Dept Med, New Orleans, LA 70112 USA
关键词
D O I
10.1053/j.gastro.2004.08.014
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Heartburn is a symptom complex that has traditionally been accepted as an acid-mediated event and a reliable indicator of gastroesophageal reflux disease. Recently, however, these concepts have been questioned because patients with endoscopy-negative "heartburn" have lower response rates to acid suppression with proton pump inhibitors than do patients with endoscopy-positive "heartburn," ie, erosive esophagitis. As explanation for this, 3 different mechanisms have been proposed to explain the occurrence of heartburn in the endoscopy-negative setting. They are: esophageal visceral hypersensitivity, sustained esophageal contractions, and abnormal tissue resistance. In this report, we review the observations in support of each concept and propose a means for reconciling them under one hypothesis: abnormal tissue resistance. Essential to this review and to the conclusions drawn about the pathogenesis of heartburn in nonerosive reflux disease is a reaffirmation of the definition of reflux-associated "heartburn" as an acid-mediated event requiring "relief by antacids" as a necessary component of the history.
引用
收藏
页码:771 / 778
页数:8
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