The anti-reflux barrier and mechanisms of gastro-oesophageal reflux

被引:35
作者
Holloway, RH [1 ]
机构
[1] Royal Adelaide Hosp, Dept Gastroenterol Hepatol & Gen Med, Adelaide, SA 5000, Australia
关键词
gastro-oesophageal reflux; oesophagogastric junction; hernia; hiatal; oesophagitis; peptic;
D O I
10.1053/bega.2000.0118
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
The lower oesophageal sphincter (LOS) is the major component of the anti-reflux barrier. The majority of reflux episodes occur because of intermittent brief complete lower oesophageal sphincter relaxations, transient LOS relaxations, rather than from chronic absence of LOS pressure. Recent advances in the understanding of the neural mechanisms and the receptors involved in the triggering of transient LOS relaxations have provided new insights into their control and offer the potential for the development of pharmacological therapy of reflux based on control of these events. Extrinsic support by the crural diaphragm is also important and loss of this support through development of hiatus hernia significantly compromises LOS function. This chapter reviews the components of the anti-reflux barrier, the patterns and mechanisms of LOS dysfunction underlying reflux episodes, and the interplay between sphincteric and non-sphincteric factors.
引用
收藏
页码:681 / 699
页数:19
相关论文
共 96 条
[1]  
Allocca M, 1999, GASTROENTEROLOGY, V116, pA111
[2]   MODULATION OF THE VAGAL DRIVE TO THE INTRAMURAL CHOLINERGIC AND NONCHOLINERGIC NEURONS IN THE FERRET STOMACH BY BACLOFEN [J].
ANDREWS, PLR ;
BINGHAM, S ;
WOOD, KL .
JOURNAL OF PHYSIOLOGY-LONDON, 1987, 388 :25-39
[3]   RELATIONSHIP OF HIATUS-HERNIA TO REFLUX ESOPHAGITIS - A PROSPECTIVE-STUDY OF COINCIDENCE, USING ENDOSCOPY [J].
BERSTAD, A ;
WEBERG, R ;
LARSEN, IF ;
HOEL, B ;
HAUERJENSEN, M .
SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, 1986, 21 (01) :55-58
[4]   Signal transduction pathways in esophageal and lower esophageal sphincter circular muscle [J].
Biancani, P ;
Sohn, UD ;
Rich, HG ;
Harnett, KM ;
Behar, J .
AMERICAN JOURNAL OF MEDICINE, 1997, 103 :23S-28S
[5]   Inhibition of transient LES relaxations and reflux in ferrets by GABA receptor agonists [J].
Blackshaw, LA ;
Staunton, E ;
Lehmann, A ;
Dent, J .
AMERICAN JOURNAL OF PHYSIOLOGY-GASTROINTESTINAL AND LIVER PHYSIOLOGY, 1999, 277 (04) :G867-G874
[6]   Mechanisms of gastro-oesophageal reflux in the ferret [J].
Blackshaw, LA ;
Staunton, WE ;
Dent, J ;
Holloway, RH ;
Malbert, CH .
NEUROGASTROENTEROLOGY AND MOTILITY, 1998, 10 (01) :49-56
[7]  
Boeckxstaens GE, 1998, AM J GASTROENTEROL, V93, P1823
[8]   PERIPHERAL AND CENTRAL SITES OF ACTION OF GABA-B AGONISTS TO INHIBIT THE COUGH REFLEX IN THE CAT AND GUINEA-PIG [J].
BOLSER, DC ;
DEGENNARO, FC ;
OREILLY, S ;
CHAPMAN, RW ;
KREUTNER, W ;
EGAN, RW ;
HEY, JA .
BRITISH JOURNAL OF PHARMACOLOGY, 1994, 113 (04) :1344-1348
[9]   Cholecystokinin in transient lower oesophageal sphincter relaxation due to gastric distension in humans [J].
Boulant, J ;
Mathieu, S ;
DAmato, M ;
Abergel, A ;
Dapoigny, M ;
Bommelaer, G .
GUT, 1997, 40 (05) :575-581
[10]  
BOWERY NG, 1992, ARZNEIMITTELFORSCH, V42-1, P215