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胃食管反流病（GERD）

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概述

当胃酸频繁回流入连接口腔和胃的管道（食管）时，发生胃食管反流病 (GERD)。这种回流（返酸）会刺激食管内膜。

许多人时不时出现返酸。GERD 是每周至少发生两次的轻度胃酸反流，或是每周至少发生一次的中度至重度胃酸反流。

可以通过改变生活方式和非处方药，管理大多数人的胃食管反流病 (GERD)的不适感。但是，有些胃食管反流病 (GERD) 患者可能需要更强效的药物甚至手术来缓解症状。

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症状

GERD 的常见体征和症状包括：

  • 胸部灼热感（胃灼热），通常在进食后发生，可能在晚上更严重
  • 胸部疼痛
  • 吞咽困难
  • 食物或酸液反流
  • 咽喉中有肿块感

如果您有夜间胃酸反流，可能还会出现：

  • 慢性咳嗽
  • 喉炎
  • 哮喘新发或加重
  • 睡眠中断

何时就诊

如果您会胸部疼痛，尤其如果还出现气短、下巴或手臂疼痛，请立即就医。这可能是心脏病发作的体征和症状。

如果您出现以下情况，请与医生约诊：

  • 经历严重或频繁的 GERD 症状
  • 每周服用两次以上治疗胃灼热的非处方药

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病因

胃食管反流病（GERD）是由频繁的胃酸反流引起的。

当您吞咽时，食管底部（食管下括约肌）周围的环形肌肉带松弛，使食物和液体流入您的胃。然后括约肌再次闭合。

如果括约肌异常松弛或变弱，胃酸就会回流到食管。持续的胃酸反流会刺激食管内膜，经常会导致发炎。

风险因素

增加患胃食管反流病 (GERD)风险的因素包括：

  • 肥胖症
  • 胃顶部隆起到横隔膜（食管裂孔疝）
  • 妊娠
  • 结缔组织病，如硬皮病
  • 胃排空延迟

加重酸反流的因素包括：

  • 吸烟
  • 暴食或深夜进食
  • 食用某些食物（诱因），如高脂或油炸食物
  • 饮用某些饮料，如酒或咖啡
  • 服用某些药物，如阿司匹林

并发症

久而久之，食管的慢性炎症会导致：

  • 食管变窄（食管狭窄）。胃酸对食管下部的损伤会导致疤痕组织形成。疤痕组织会使食物通道缩窄，导致吞咽问题。
  • 食管开放性溃疡（食管溃疡）。胃酸会侵蚀食管内的组织，导致形成开放性溃疡。食管溃疡会出血，引起疼痛和吞咽困难。
  • 食管癌前病变（巴雷特食管）。胃酸造成的损伤会导致食管下层组织发生改变。这些改变与食管癌风险增加有关。

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胃食管反流病（GERD）

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