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食管动力障碍和胃食管反流病
Esophageal Motility Disorders and Gastroesophageal Reflux Disease


Ravinder Mittal ... 其他 • 2020.11.12
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吞咽困难、胃灼热、反流和非心源性胸痛是食管动力异常和反流疾病的症状。在门诊,胃食管反流病(GERD)是第二常见的消化道疾病诊断(最常见的是腹痛)1。北美约有18%~28%的人患GERD 2。GERD的潜在并发症包括狭窄、巴雷特食管和食管腺癌。在医疗费用方面,2015年食管疾病的医疗费达到181亿美元(仅次于肝炎),其中124亿美元用于抑酸治疗(H2受体阻滞剂和质子泵抑制剂)1。食管动力障碍和GERD属于良性疾病,死亡率很低,但对健康质量有显著影响。

 

食管下括约肌


食管胃交界处的括约肌机制包括由平滑肌构成的食管下括约肌和由骨骼肌构成的膈脚,它们分别称为食管内下括约肌和食管外下括约肌(internal and external lower esophageal sphincter)。食管下括约肌的平滑肌(由钩状纤维[clasp fiber]和套索纤维[sling fiber]组成3)(图1A)具有不同的生理特性和神经支配4,5。人食管下括约肌横切面的三维重建显示了其独特的肌结构6,7。食管下括约肌的环行肌在His角相互交叉,并继续作为套索纤维进入胃内;食管下括约肌的后面这一部分有几个名字,包括胃的内斜肌层、Helvitus颈(collar of Helvitus,1719年命名)和贲门威利斯环(cardiac loop of Willis,1674年命名)8。右膈脚也有独特的肌结构;它分为两个肌束,肌束在食管裂孔的后下端和腹上端以剪刀样的方式互相交叉并环绕食管(图1B)7。肛门外括约肌的肌束也在肛管的背侧和腹侧两端交叉9。人体的每个括约肌是否有独特肌结构需要研究,因为肌结构对于以下两方面有重要影响:每个括约肌如何使孔口环向关闭,以及功能障碍是如何发生。





作者信息

Ravinder Mittal, M.D., and Michael F. Vaezi, M.D., Ph.D.
From the Division of Gastroenterology, Department of Medicine, University of California, San Diego, San Diego (R.M.); and the Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville (M.F.V.). Address reprint requests to Dr. Mittal at the Altman Clinical and Translational Research Institute, 9500 Gillman Dr., MC 0061, La Jolla, CA 92093-0990, or at rmittal@ucsd.edu.

 

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