西安交通大学医学院消化系统疾病课件 Gastroesophageal Reflux Disease.pptVIP

Gastroesophageal Reflux Disease Department of Gastroenterology Qiao Wen GERD is common in the West Country. 7% to 15% of patients have the symptoms of gastroesophageal reflux. The sex ratio of GERD is roughly equal proportions of affected males and females but a male preponderance of esophagitis (2:1 to 3:1) and of Barrett’s esophagus. The epidemiological study in Shanghai and Beijing showed the prevalence rate of GERD is 5.77% and RE is 1.92%. Etiology and Pathogenesis GERD is a disease of power disturbance of upper digest tract to be made by multifactor. The pathogenesis of GERD is the balance destruction between aggressive forces (acid reflux, potency of refluxate) and defensive forces (esophageal acid clearance, mucosal resistance). Etiology and Pathogenesis Mechanism of Esophageal Antireflux Decreasing The mechanisms of antireflux include antireflux barrier, esophageal reflux clearance and mucosal defensive factors. Etiology and Pathogenesis Antireflux Decreasing Under normal circumstances, astroesophageal reflux is prevented by the anatomic structure of gastroesophageal junction, Etiology and Pathogenesis it includes lower esophageal sphincter (LES), diaphragmatic sphincter, phrenoesophageal ligament, and an acute angle between esophagus and stomach (His angle). Etiology and Pathogenesis functional circumstance of LES is most important. Resting tone of the LES varies among normal individuals from 10-30 mmHg. LES pressure is lowest in the postprandial peroid and highest at night. Etiology and Pathogenesis Normal individual there is a little reflux in the postprandial peroid, but the antireflux defensive system exits and this physiologic reflux is transient, so the esophageal mucosa can be damaged and is asymptom. Etiology and Pathogenesis Etiology and Pathogenesis Sometimes the pressure of LES is normal, but the transit LES relaxation (TLESR) frequently appears, the gastric contents also ref