위식도 역류질환의 최신지견
Gastroesophageal Reflux Disease: An Update
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초록
Gastroesophageal reflux disease (GERD) is a condition that develops when the reflux of gastric contents causes troublesome symptoms or complications. Typical symptoms are heartburn and acid regurgitation; extraesophageal manifestations include chronic cough, reflux laryngitis, asthma, non-cardiac chest pain and dental erosion. GERD can be presented as esophagitis or Barrett’s esophagus; nonerosive reflux disease (NERD) is defined as no visible esophageal erosions but objective evidence that a patient’s symptoms are caused by gastro-esophageal reflux. Transient LES relaxations (tLESRs) and hiatal hernia are the main mechanisms underlying gastroesophageal reflux, and the acid pocket relative to the diaphragm is a major determinant of the acidity of the refluxate. Especially, in patients with NERD, increased permeability due to impaired mucosal barrier may contribute to symptom generation. The mainstay of pharmacologic therapy for GERD is gastric acid suppression with proton pump inhibitors (PPIs), and PPIs are superior to histamine-2 receptor antagonist (H2RAs) for mucosal healing of erosive esophagitis and achieving symptom control. Prokinetics, cytoprotective agents and tLESR inhibitors such as baclofen also may be effective, but have only limited data. GERD could be a chronic relapsing disease, so maintenance therapy (either continuous or on-demand therapy) may be required following successful initial treatment.
Abstract
Gastroesophageal reflux disease (GERD) is a condition that develops when the reflux of gastric contents causes troublesome symptoms or complications. Typical symptoms are heartburn and acid regurgitation; extraesophageal manifestations include chronic cough, reflux laryngitis, asthma, non-cardiac chest pain and dental erosion. GERD can be presented as esophagitis or Barrett’s esophagus; nonerosive reflux disease (NERD) is defined as no visible esophageal erosions but objective evidence that a patient’s symptoms are caused by gastro-esophageal reflux. Transient LES relaxations (tLESRs) and hiatal hernia are the main mechanisms underlying gastroesophageal reflux, and the acid pocket relative to the diaphragm is a major determinant of the acidity of the refluxate. Especially, in patients with NERD, increased permeability due to impaired mucosal barrier may contribute to symptom generation. The mainstay of pharmacologic therapy for GERD is gastric acid suppression with proton pump inhibitors (PPIs), and PPIs are superior to histamine-2 receptor antagonist (H2RAs) for mucosal healing of erosive esophagitis and achieving symptom control. Prokinetics, cytoprotective agents and tLESR inhibitors such as baclofen also may be effective, but have only limited data. GERD could be a chronic relapsing disease, so maintenance therapy (either continuous or on-demand therapy) may be required following successful initial treatment.
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