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Gastro‑oesophageal reflux disease in liver cirrhosis: Possible pathogenesis and clinical intervention (Review)

Oesophageal variceal bleeding is a common complication of decompensated liver cirrhosis (LC). Some studies have reported that reflux oesophagitis (RE) is a risk factor for upper gastrointestinal bleeding, and greatly impacts the quality of life. However, the frequency and mechanism of gastro-oesopha...

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Autores principales: Yu, Fei, Zhu, Yue, Li, Na, Fu, Hong-Fang, Jiang, Zhi, Zhang, Xiao-Yi, Zeng, Liang, Hu, Xiao-Yu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: D.A. Spandidos 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10407984/
https://www.ncbi.nlm.nih.gov/pubmed/37559931
http://dx.doi.org/10.3892/etm.2023.12113
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author Yu, Fei
Zhu, Yue
Li, Na
Fu, Hong-Fang
Jiang, Zhi
Zhang, Xiao-Yi
Zeng, Liang
Hu, Xiao-Yu
author_facet Yu, Fei
Zhu, Yue
Li, Na
Fu, Hong-Fang
Jiang, Zhi
Zhang, Xiao-Yi
Zeng, Liang
Hu, Xiao-Yu
author_sort Yu, Fei
collection PubMed
description Oesophageal variceal bleeding is a common complication of decompensated liver cirrhosis (LC). Some studies have reported that reflux oesophagitis (RE) is a risk factor for upper gastrointestinal bleeding, and greatly impacts the quality of life. However, the frequency and mechanism of gastro-oesophageal reflux disease (GERD) in LC remain unclear. The present review explored the possible pathogenesis, and analysed the advantages and disadvantages of the interventional measures and the need for implementation of these measures. By combining the comprehensive terms associated with LC, GERD and RE, EMBASE, Medline/PubMed and the Cochrane Library were systematically searched. The underlying pathological mechanism of GERD in LC was summarized: Transient relaxation of the lower oesophageal sphincter, delayed gastric emptying, increased intra-abdominal pressure, increased intragastric pressure and excessive nitric oxide production destroyed the ‘anti-reflux barrier’, causing gastric content reflux. Proton pump inhibitors (PPIs) have been widely used empirically to lower the risk of oesophageal venous rupture and bleeding. However, long-term use of acid inhibitors in patients with LC may induce complications, such as spontaneous bacterial peritonitis. The metabolic half-life of PPIs is prolonged in patients with severe liver function impairment. Therefore, the indications for using acid inhibitors lack clarity. However, after endoscopic oesophageal variceal eradication, additional benefits may be gained from the long-term use of PPIs in small doses.
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spelling pubmed-104079842023-08-09 Gastro‑oesophageal reflux disease in liver cirrhosis: Possible pathogenesis and clinical intervention (Review) Yu, Fei Zhu, Yue Li, Na Fu, Hong-Fang Jiang, Zhi Zhang, Xiao-Yi Zeng, Liang Hu, Xiao-Yu Exp Ther Med Review Oesophageal variceal bleeding is a common complication of decompensated liver cirrhosis (LC). Some studies have reported that reflux oesophagitis (RE) is a risk factor for upper gastrointestinal bleeding, and greatly impacts the quality of life. However, the frequency and mechanism of gastro-oesophageal reflux disease (GERD) in LC remain unclear. The present review explored the possible pathogenesis, and analysed the advantages and disadvantages of the interventional measures and the need for implementation of these measures. By combining the comprehensive terms associated with LC, GERD and RE, EMBASE, Medline/PubMed and the Cochrane Library were systematically searched. The underlying pathological mechanism of GERD in LC was summarized: Transient relaxation of the lower oesophageal sphincter, delayed gastric emptying, increased intra-abdominal pressure, increased intragastric pressure and excessive nitric oxide production destroyed the ‘anti-reflux barrier’, causing gastric content reflux. Proton pump inhibitors (PPIs) have been widely used empirically to lower the risk of oesophageal venous rupture and bleeding. However, long-term use of acid inhibitors in patients with LC may induce complications, such as spontaneous bacterial peritonitis. The metabolic half-life of PPIs is prolonged in patients with severe liver function impairment. Therefore, the indications for using acid inhibitors lack clarity. However, after endoscopic oesophageal variceal eradication, additional benefits may be gained from the long-term use of PPIs in small doses. D.A. Spandidos 2023-07-12 /pmc/articles/PMC10407984/ /pubmed/37559931 http://dx.doi.org/10.3892/etm.2023.12113 Text en Copyright: © Yu et al. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License (https://creativecommons.org/licenses/by-nc-nd/4.0/) , which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
spellingShingle Review
Yu, Fei
Zhu, Yue
Li, Na
Fu, Hong-Fang
Jiang, Zhi
Zhang, Xiao-Yi
Zeng, Liang
Hu, Xiao-Yu
Gastro‑oesophageal reflux disease in liver cirrhosis: Possible pathogenesis and clinical intervention (Review)
title Gastro‑oesophageal reflux disease in liver cirrhosis: Possible pathogenesis and clinical intervention (Review)
title_full Gastro‑oesophageal reflux disease in liver cirrhosis: Possible pathogenesis and clinical intervention (Review)
title_fullStr Gastro‑oesophageal reflux disease in liver cirrhosis: Possible pathogenesis and clinical intervention (Review)
title_full_unstemmed Gastro‑oesophageal reflux disease in liver cirrhosis: Possible pathogenesis and clinical intervention (Review)
title_short Gastro‑oesophageal reflux disease in liver cirrhosis: Possible pathogenesis and clinical intervention (Review)
title_sort gastro‑oesophageal reflux disease in liver cirrhosis: possible pathogenesis and clinical intervention (review)
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10407984/
https://www.ncbi.nlm.nih.gov/pubmed/37559931
http://dx.doi.org/10.3892/etm.2023.12113
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