难治性反流性食管炎的中西医研究进展

Research progress in traditional Chinese and Western medicine for refractory reflux esophagitis

摘要:

难治性反流性食管炎（RRE）是胃食管反流病中对标准剂量质子泵抑制剂治疗应答欠佳的复杂亚型，其发病机制涉及食管胃结合部屏障功能受损、食管高敏感性、基因多态性、精神心理因素及脑-肠互动异常等多因素的交互作用。近年来，高分辨率阻抗测压、24 h pH-阻抗监测等精准检测手段逐步推广，显著提升了RRE的诊断与鉴别诊断水平。西医治疗方面，强化抑酸、内镜介入及抗反流手术等策略持续演进；中医治疗则立足“胃失和降”的核心病机，以辨证论治为指导，采用中药复方、针灸等综合手段进行整体调节，展现出独特的临床价值。中西医结合治疗优势互补，在改善症状、降低复发率及提高生活质量方面显示出良好前景。未来研究应聚焦于深入探索发病机制、统一诊断标准、完善中医药循证评价体系，并优化与推广中西医结合诊疗路径。

Abstract:

Refractory reflux esophagitis (RRE) is a complex subtype of gastroesophageal reflux disease (GERD) characterized by a poor response to standard-dose proton pump inhibitor therapy. Its pathogenesis involves interactions among multiple factors, including impaired esophagogastric junction barrier function, esophageal hypersensitivity, genetic polymorphisms, psychological factors, and abnormal brain-gut interactions. In recent years, the increasing use of precise diagnostic techniques, such as high-resolution impedance manometry and 24 h pH-impedance monitoring, has significantly improved the diagnosis and differential diagnosis of RRE. In Western medicine, strategies such as intensified acid suppression, endoscopic intervention, and antireflux surgery continue to evolve. Traditional Chinese medicine (TCM), guided by the core pathogenesis of "failure of the stomach to maintain harmony and descend", uses herbal formulas, acupuncture, and other comprehensive approaches for holistic regulation and has shown distinct clinical value. Integrated traditional Chinese and Western medicine offers complementary advantages and shows promise in relieving symptoms, reducing recurrence, and improving quality of life. Future research should focus on further elucidating the pathogenesis, unifying diagnostic standards, improving the evidence-based evaluation system for TCM, and optimizing and promoting integrated diagnostic and treatment pathways.