成人胃食管反流病的并发症
- Author
- Peter J Kahrilas, MD
Peter J Kahrilas, MD
- Professor of Medicine
- Feinberg School of Medicine, Northwestern University
- Section Editor
- Nicholas J Talley, MD, PhD
Nicholas J Talley, MD, PhD
- Section Editor — Motility Disorders
- Professor of Medicine, University of Newcastle, Australia
- Adjunct Professor of Medicine and Epidemiology and Consultant, Mayo Clinic, Rochester, MN
- Adjunct Professor, University of North Carolina
- Deputy Editor
- Shilpa Grover, MD, MPH, AGAF
Shilpa Grover, MD, MPH, AGAF
- Deputy Editor — Gastroenterology/Hepatology
- Assistant Professor of Medicine, Part-time
- Harvard Medical School
- Translators
- 严苏, 主任医师，副教授
严苏, 主任医师，副教授
- 苏州大学附属第一医院消化内科
引言
胃食管反流病(gastroesophageal reflux disease, GERD)的并发症大致可被分为3类：
- 食管炎，可伴有多种症状，包括烧心、反流和吞咽困难(参见“成人胃食管反流的临床表现和诊断”)
- 食管炎修复过程的后果(消化性狭窄和Barrett化生)
- 反流的食管外临床表现，如哮喘、喉炎和咳嗽
本专题将讨论除食管炎外的其他反流并发症，这些并发症的严重程度呈连续性增加。该病的病理生理学、Barrett化生的后果及食管炎的内科和外科治疗参见其他专题。
消化性狭窄
狭窄是溃疡性食管炎愈合过程的一个结果。愈合过程中胶原沉积，并且随着时间的推移，胶原纤维收缩，导致食管腔狭窄。狭窄的长度通常较短并与胃食管连接部相连；内镜检查也可能发现反流性食管炎毗邻的区域受累(图片 1和影像 1)。 它们产生的主要症状是固体食物的吞咽困难和发作性食管梗阻。
治疗 — 许多报道已证实通过扩张的方式对良性狭窄进行保守治疗可以获益[1,2]。用填充汞的圆形或锥形扩张器机械性扩张食管可显著减轻吞咽困难。 这通常需要将管腔直径扩张至大于等于14mm(44F)。僵硬的、扭曲的或严重狭窄的食管可能需要内镜下放置球囊扩张器，或也可在内镜引导下或透视镜下置入金属导丝放置扩张器。 (参见“良性食管狭窄的治疗”)
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