Reflux esophagitis Causes
Reflux esophagitis is caused by following factors:
1. Gastroesophageal junction anatomy and physiology of anti-reflux barrier damage:
gastroesophageal junction anti-reflux barrier, also known as the first anti-reflux screen, one of the most important structure is the lower esophageal sphincter (lower esophageal sphincter, LES) . LES is in the esophagus and stomach at the junction of 3 ~ 5cm above the scope of the high-pressure zone. The resting pressure of about 2.0 ~ 4.0kPa (15 ~ 30mmHg), form a pressure barrier to prevent the stomach contents play a counter-flow of the physiological role of esophagus. Through the normal increase in intra-abdominal pressure caused by vagus nerve reflex contraction of LES to LES pressure increased by leaps and bounds in order to prevent GER. LES pressure is too low and not intra-abdominal pressure caused by a strong increase in contractile response of LES, and could lead to GER. Study shows that, LESD <0.8kPa, it is prone to reflux, about 17% ~ 39% of reflux esophagitis were related GER. Cholinergic and β-adrenergic drugs may be, α-adrenergic antagonists, more security, stability, calcium receptor antagonist, morphine and fat, alcohol, caffeine and smoking, such as drug and food factors can affect the LES function, induced by GER. In addition, pregnancy, oral contraceptives containing progesterone late period and the menstrual cycle, plasma progesterone levels increased, GER incidence also increased.
2. Obstacles of esophageal acid clearance function:
normal esophageal acid clearance include esophageal emptying and saliva and in two parts. When the acid reflux of gastric contents, just 1 or 2 times (about 10 ~ 15 seconds) iri secondary esophageal peristalsis can be emptied almost all the anti-flow structures. Residual esophageal mucosa in the pits can be a small amount of acid saliva (normal about an hour 1000 ~ 1500ml, pH 6 ~ 8 Transesophageal saliva enter stomach) and. The function of esophageal acid clearance is reduced in gastric mucosa of immersion time limit, it is to prevent reflux esophagitis role. The study found the majority of esophageal emptying abnormalities in early-onset esophagitis, and by the reduction in saliva secretion occurred while rare esophagitis. Saliva secreted during sleep at night almost ceased, secondary esophageal peristalsis are also a rare occurrence at night significantly delayed esophageal acid clearance, GER night it is even more serious harm.
3. Anti-reflux esophageal mucosal barrier function damage:
anti-reflux esophageal mucosal barrier function composed of the following factors:
4. Gastroduodenal dysfunction:
Gastroduodenal reflux: Under normal circumstances, epithelial cells in esophageal squamous keratinized surface to prevent infiltration of mucosal H +, to protect the esophageal mucosa from acid reflux surface material damage. When the pyloric sphincter LES tension and the lower pressure at the same time, the gastric juice of hydrochloric acid and pepsin, the acid in the duodenal juice, pancreatic juice and hemolytic lecithin can be at the same time, such as anti-inflow esophagus, esophageal erosion of the keratinized epithelial cell layer , and thinning or loss. Reflux material in H + and pepsin through the new layer of squamous cell esophageal tissues and in-depth, cause esophagitis.
Therefore, reflux esophagitis is results that the bile reflux and gastric acid together effect to esophagus. The cause of esophageal injury in the bile before entering the existence of Helicobacter pylori and LES dysfunction; reflux esophagitis with gastritis more . Sliding hiatal hernia often due to Helicobacter pylori-induced LES dysfunction and complications of the disease easily; duodenal ulcer accompanied by a high number of gastric acid secretion and gastric antral easily lead to pyloric spasm and dysfunction, it is also more complicated with this disease. Obesity, a large number of ascites, the latter part of pregnancy, increased intragastric pressure and other factors could induce Reflux esophagitis.