Trào ngược dạ dày-thực quản bệnh (GORD) là một thuật ngữ được sử dụng để bao gồm các bệnh nhân chịu đau khổ với các triệu chứng của trào ngược, có hoặc không có viêm thực quản hoặc bất kỳ biến chứng khác của trào ngược axit | 20 GASTROINTESTINAL CAUSES OF CHEST PAIN GASTRO-OESOPHAGEAL REFLUX DISEASE Gastro-oesophageal reflux disease GORD is a term used to include patients who suffer with symptoms of reflux with or without oesophagitis or any other complication of acid reflux and who mayor may not have a hiatus hernia. Oesophagitis ranges from minor microscopic changes of an acute inflammatory infiltrate with neutrophils and eosinophils to mucosal erosions and ulceration. As the damaging agents are luminal damage is predominantly mucosal and perforation is unusual. Normally prevention of acid damage is achieved by a combination of physiological barriers. The LOS is a 3 4- cm long collection of smooth muscle fibres which maintains a resting tone of 10-30 mmHg pressure. There is also extrinsic pressure exerted from the crura of the diaphragm at the same point and the angle of His the angle of entry of the oesophagus into the stomach which both help retain acid within the stomach. Periods of LOS relaxation occur in all individuals and allow transient reflux of acid into the oesophagus. This initiates a distal oesophageal peristaltic wave which progressively clears the acid. Swallowed saliva is alkaline and also helps neutralise oesophageal acid Fig. 1 . It is probably true that there is no single failure of any one of these preventative mechanisms in GORD and the disease probably reflects a combination of them. Hiatus hernia displacement of the LOS into the chest is extremely common and many patients attribute GORD to its presence but it is probably only a minor contributory factor. Symptomatic reflux is usually accompanied by no oesophageal mucosal changes and the severity of symptoms does not correlate with the presence or abscence of oeso-phagi-tis however duration of acid exposure is related to the degree of oesophagitis. Chronic reflux may result in stricture formation and the development of Barrett s oesophagus. Recent work has suggested that long-term severe reflux significantly .
