medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2020-37-11-16medalphabet-1859Research ArticleСтатьиДуоденогастроэзофагеальный рефлюкс: современное состояние проблемыDuodenogastroesophageal reflux: current state of issueУспенскийЮ. П.UspenskiyYu. P.

д. м. н., проф., зав. кафедрой факультетской терапии им. проф. В. А. Вальдмана, проф. кафедры внутренних болезней стоматологического факультета

Санкт-Петербург 

Saint Petersburg

ФоминыхЮ. А.FominykhYu. A.

к. м. н., доцент, доцент кафедры внутренних болезней стоматологического факультета

Санкт-Петербург

Saint Petersburg

ГнутовА. А.GnutovA. A.

ассистент кафедры факультетской терапии им. проф. В. А. Вальдмана

Санкт-Петербург

Saint Petersburg

ФГБОУ ВО «Санкт-Петербургский государственный педиатрический медицинский университет» Минздрава России; ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. Павлова» Минздрава РоссииРоссияSaint Petersburg State Pediatric Medical University; First Saint Petersburg State Medical University n. a. I. P. PavlovRussian FederationФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. Павлова» Минздрава РоссииРоссияFirst Saint Petersburg State Medical University n. a. I. P. PavlovRussian FederationФГБОУ ВО «Санкт-Петербургский государственный педиатрический медицинский университет» Минздрава РоссииРоссияSaint Petersburg State Pediatric Medical UniversityRussian Federation202015012021037Практическая гастроэнтерология (4)1115Copyright © Успенский Ю.П., Фоминых Ю.А., Гнутов А.А., 20212021Успенский Ю.П., Фоминых Ю.А., Гнутов А.А.Uspenskiy Y.P., Fominykh Y.A., Gnutov A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/1859

В статье представлены данные о современных взглядах на проблему дуоденогастроэзофагеального рефлюкса, рассматриваются ключевые особенности физиологии желчных кислот, роль желчных кислот в патогенезе гастроэзофагеальной рефлюксной болезни, пищевода Барретта и аденокарциномы пищевода. В обзоре приведены актуальные методы диагностики дуоденогастроэзофагеального рефлюкса, обсуждаются подходы к медикаментозной коррекции.

The article presents data on modern views on the problem of duodenogastroesophageal reflux, examines the key features of the physiology of bile acids, the role of bile acids in the patho- genesis of gastroesophageal reflux disease, Barrett's esophagus and esophageal adenocarcinoma. The review presents current methods for diagnosing duodenogastroesophageal reflux, discusses treatment approaches.

дуоденогастроэзофагеальный рефлюксжелчные кислотыфиброоптическая спектрофотометрия билирубинасуточная импеданс-pH-метрияduodenogastroesophageal refluxbile acidsfibrooptic spectrophotometry of bilirubindaily impedance-pH-metryReferencesS. Kunsch et al. Increased Duodeno-Gastro-Esophageal Reflux (DGER) in Symptomatic GERD Patients with a History of Cholecystectomy. Z Gastroenterol, 2009; 47: 744–748.S. Kunsch et al. Increased Duodeno-Gastro-Esophageal Reflux (DGER) in Symptomatic GERD Patients with a History of Cholecystectomy. Z Gastroenterol, 2009; 47: 744–748.Маев И. В., Андреев Д. Н., Кучерявый Ю. А., Щегланова М. П. Аденокарцинома пищевода: факторы риска и современные стратегии скрининга. Рос. журн. гастроэнтерол гепатол колопроктол 2017; 27 (2): 4–12.Mayev I. V., Andreyev D. N., Kucheryavy Yu.A., Scheglanova M. P. Esophageal adenocarcinoma: risk factors and modern screening strategy. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2017; 27 (2): 4–12. (In Russ.) https://doi.org/10.22416/1382–4376–2017–27–2–4–12J. Tack. Review article: role of pepsin and bile in gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2005; 22 (1): 48–54.J. Tack. Review article: role of pepsin and bile in gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2005; 22 (1): 48–54.M. F. Dixon, P. M. Neville, N. P. Mapstone, P. Moayyedi, A.T.R Axon. Bile reflux gastritis and Barrett’s oesophagus: further evidence of a role for duodenogastrooesophageal reflux? Gut 2001; 49: 359–363.M. F. Dixon, P. M. Neville, N. P. Mapstone, P. Moayyedi, A.T.R Axon. Bile reflux gastritis and Barrett’s oesophagus: further evidence of a role for duodenogastrooesophageal reflux? Gut 2001; 49: 359–363.Ильченко А. А. Желчные кислоты в норме и при патологии. Экспериментальная и клиническая гастроэнтерология. 2010; 4: 3–13.Ilchenko A. A. Bile acids in health and disease. Experimental and clinical gastroenterology. 2010; 4: 3–13В. Б. Гриневич, Е. И. Сас. Физиологические эффекты желчных кислот. РМЖ. Медицинское обозрение. 2017; 2: 87–91.Grinevich V. B., Sas E. I. Physiological effects of bile acids. RMJ. Medical review. 2017; (2): 87–91Евсютина Ю. В., Ивашкин В. Т. Метаболизм желчных кислот, заболевания печени и микробиом. Рос журн гастроэнтерол гепатол колопроктол 2018; 28 (2): 4–10. DOI: 10.22416/1382–4376–2018–28–2–4–10.Yevsyutina Yu.V., Ivashkin V. T. Metabolism of bile acids, liver diseases and microbiome. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2018; 28 (2): 4–10. (In Russ.) https://doi. org/10.22416/1382–4376–2018–28–2–4–10].A. F. Hofmann, L. R. Hagey. Bile Acids: Chemistry, Pathochemistry, Biology, Pathobiology, and Therapeutics. Cell. Mol. Life Sci. 2008; 65: 2461–2483.A. F. Hofmann, L. R. Hagey. Bile Acids: Chemistry, Pathochemistry, Biology, Pathobiology, and Therapeutics. Cell. Mol. Life Sci. 2008; 65: 2461–2483.Thomas A. Eldredge, Jennifer C. Myers, George K. Kiroff, Jonathan Shenfine. Detecting Bile Reflux – the Enigma of Bariatric Surgery. Obesity Surgery 2018; 28: 559–566.Thomas A. Eldredge, Jennifer C. Myers, George K. Kiroff, Jonathan Shenfine. Detecting Bile Reflux – the Enigma of Bariatric Surgery. Obesity Surgery 2018; 28: 559–566.Ш. З. Галиев, Н. Б. Амиров. Дуоденогастральный рефлюкс как причина развития рефлюкс-гастрита. Вестник современной клинической медицины. 2015; 8 (2). 50–61.S. Z. Galiev, N. B. Amirov. Duodenogastric reflux as a cause of reflux-gastritis. Bulletin of modern clinical medicine. 2015; 8 (2). 50–61А. Ф. Юсупова, Н. М. Валиуллина, А. Х. Одинцова. Динамическая сцинтиграфия гепатобилиарной системы в диагностике постхолецистэктомического синдрома. Казанский медицинский журнал, 2007; 88 (1): 44–46.A. F. Yusupova, N. M. Valiullina, A. Kh. Odintsova. Dynamic scintigraphy of hepatobiliary system in the diagnosis of post-chole-cystectomy syndrome. 2007; 88 (1): 44–46F. Pace, O. Sangaletti, S. Pallotta, P. Molteni, G. Bianchi Porro. Biliary reflux and non-acid reflux are two distinct phenomena: A comparison between 24-hour multichannel intraesophageal impedance and bilirubin monitoring. Scandinavian Journal of Gastroenterology, 2007; 42: 1031–1039.F. Pace, O. Sangaletti, S. Pallotta, P. Molteni, G. Bianchi Porro. Biliary reflux and non-acid reflux are two distinct phenomena: A comparison between 24-hour multichannel intraesophageal impedance and bilirubin monitoring. Scandinavian Journal of Gastroenterology, 2007; 42: 1031–1039.M. F. Vaezi, J. E. Richter. Role of Acid and Duodenogastroesophageal Reflux in Gastroesophageal Reflux Disease. Gastroenterology, 1996; 111: 1192–1199.M. F. Vaezi, J. E. Richter. Role of Acid and Duodenogastroesophageal Reflux in Gastroesophageal Reflux Disease. Gastroenterology, 1996; 111: 1192–1199.D. Nehra, P. Howell, C. P. Williams, J. K. Pye, J. Beynon. Toxic bile acids in gastro-oesophageal reflux disease: influence of gastric acidity. Gut, 1999; 44: 598–602.D. Nehra, P. Howell, C. P. Williams, J. K. Pye, J. Beynon. Toxic bile acids in gastro-oesophageal reflux disease: influence of gastric acidity. Gut, 1999; 44: 598–602.Monaco L, Brillantino A, Torelli F, Schettino M, Izzo G, Cosenza A, Di Martino N. Prevalence of bile reflux in gastroesophageal reflux disease patients not responsive to proton pump inhibitors. World J Gastroenterol 2009; 15 (3): 334–338.Monaco L, Brillantino A, Torelli F, Schettino M, Izzo G, Cosenza A, Di Martino N. Prevalence of bile reflux in gastroesophageal reflux disease patients not responsive to proton pump inhibitors. World J Gastroenterol 2009; 15 (3): 334–338.A. Kawabea et al. Production of prostaglandin E 2 via bile acid is enhanced by trypsin and acid in normal human esophageal epithelial cells. Life Sciences, 2004; 75: 21–34.A. Kawabea et al. Production of prostaglandin E 2 via bile acid is enhanced by trypsin and acid in normal human esophageal epithelial cells. Life Sciences, 2004; 75: 21–34.S. P. Duggan et al. An integrative genomic approach in oesophageal cells identifies TRB 3 as a bile acid responsive gene, downregulated in Barrett’s oesophagus, which regulates NF-kB activation and cytokine levels. Carcinogenesis, 2010; 31 (5): 936–945.S. P. Duggan et al. An integrative genomic approach in oesophageal cells identifies TRB 3 as a bile acid responsive gene, downregulated in Barrett’s oesophagus, which regulates NF-kB activation and cytokine levels. Carcinogenesis, 2010; 31 (5): 936–945.Zhang R, Gong J, Wang H, Wang L. Bile salts inhibit growth and induce apoptosis of cultured human normal esophageal mucosal epithelial cells. World J Gastroenterol 2005; 11 (41): 6466–6471Zhang R, Gong J, Wang H, Wang L. Bile salts inhibit growth and induce apoptosis of cultured human normal esophageal mucosal epithelial cells. World J Gastroenterol 2005; 11 (41): 6466–6471T. Liu et al. Regulation of Cdx2 expression by promoter methylation, and effects of Cdx2 transfection on morphology and gene expression of human esophageal epithelial cells. Carcinogenesis, 2007; 28 (2): 488–496.T. Liu et al. Regulation of Cdx2 expression by promoter methylation, and effects of Cdx2 transfection on morphology and gene expression of human esophageal epithelial cells. Carcinogenesis, 2007; 28 (2): 488–496.D. J. Morrow et al. Pathogenesis of Barrett’s esophagus: Bile acids inhibit the Notch signaling pathway with induction of CDX2 gene expression in human esophageal cells. Surgery, 2009; 146(4): 714–722.D. J. Morrow et al. Pathogenesis of Barrett’s esophagus: Bile acids inhibit the Notch signaling pathway with induction of CDX2 gene expression in human esophageal cells. Surgery, 2009; 146(4): 714–722.K. R. McQuaid, L. Laine, M. B. Fennerty, R. Souza, S. J. Spechler. Systematic review: the role of bile acids in the pathogenesis of gastro-oesophageal reflux disease and related neoplasia. Aliment Pharmacol Ther, 2011; 34: 146–165.K. R. McQuaid, L. Laine, M. B. Fennerty, R. Souza, S. J. Spechler. Systematic review: the role of bile acids in the pathogenesis of gastro-oesophageal reflux disease and related neoplasia. Aliment Pharmacol Ther, 2011; 34: 146–165.K. Dvorak et al. Expression of Bile Acid Transporting Proteins in Barrett’s Esophagus and Esophageal Adenocarcinoma. Am J Gastroenterol. 2009 February; 104 (2): 302–309.K. Dvorak et al. Expression of Bile Acid Transporting Proteins in Barrett’s Esophagus and Esophageal Adenocarcinoma. Am J Gastroenterol. 2009 February; 104 (2): 302–309.Hashimoto N. Cholecystectomy and Duodenogastric Reflux: Reflux of Duodenal Content Induces Esophageal Carcinogenesis. Clin Surg. 2018; 3: 1867.Hashimoto N. Cholecystectomy and Duodenogastric Reflux: Reflux of Duodenal Content Induces Esophageal Carcinogenesis. Clin Surg. 2018; 3: 1867.D. Sun et al. Bile acids but not acidic acids induce Barrett’s esophagus. Int J Clin Exp Pathol 2015; 8 (2): 1384–1392.D. Sun et al. Bile acids but not acidic acids induce Barrett’s esophagus. Int J Clin Exp Pathol 2015; 8 (2): 1384–1392.J. E. Richter. Duodenogastric Reflux-induced (Alkaline) Esophagitis. Current Treatment Options in Gastroenterology, 2004; 7: 53–58.J. E. Richter. Duodenogastric Reflux-induced (Alkaline) Esophagitis. Current Treatment Options in Gastroenterology, 2004; 7: 53–58.M. F. Dixon, P. M. Neville, N. P. Mapstone, P. Moayyedi, A.T.R Axon. Bile reflux gastritis and Barrett’s oesophagus: further evidence of a role for duodenogastro-oesophageal reflux? Gut 2001; 49: 359–363.M. F. Dixon, P. M. Neville, N. P. Mapstone, P. Moayyedi, A.T.R Axon. Bile reflux gastritis and Barrett’s oesophagus: further evidence of a role for duodenogastro-oesophageal reflux? Gut 2001; 49: 359–363.S. Kuran. Bile reflux index after therapeutic biliary procedures. BMC Gastroenterology, 2008; 8: 4.S. Kuran. Bile reflux index after therapeutic biliary procedures. BMC Gastroenterology, 2008; 8: 4.E. Mercan, U. Duman, D. Tihan, E. Dilektasli, K Senol. Cholecystectomy and duodenogastric reflux: interacting effects over the gastric mucosa. Springer Plus, 2016; 5: 1970.E. Mercan, U. Duman, D. Tihan, E. Dilektasli, K Senol. Cholecystectomy and duodenogastric reflux: interacting effects over the gastric mucosa. Springer Plus, 2016; 5: 1970.Jacob Freedman, Weimin YE, Erik Naslund, and Jesper Lagergren. Association Between Cholecystectomy and Adenocarcinoma of the Esophagus. Gastroenterology 2001; 121. 548–553.Jacob Freedman, Weimin YE, Erik Naslund, and Jesper Lagergren. Association Between Cholecystectomy and Adenocarcinoma of the Esophagus. Gastroenterology 2001; 121. 548–553.Успенский Ю. П., Иванов С. В., Вовк А. В. Эволюция подходов к лечению желчнокаменной болезни. Дневник Казанской медицинской школы 2018; 4(22): 109–116.Uspenskiy Y. P., Ivanov S. V., Vovk A. V. The evolution of approaches to the gallstone disease treatment. Diary of the Kazan Medical School 2018; 4 (22). 109–116Kunsch S. et al. Impact of Pantoprazole on Duodeno-Gastro-Esophageal Reflux (DGER). Z Gastroenterol 2009; 47: 277–282.Kunsch S. et al. Impact of Pantoprazole on Duodeno-Gastro-Esophageal Reflux (DGER). Z Gastroenterol 2009; 47: 277–282.G. H. Koek, D. Sifrim, T. Lerut, J. Janssens, J. Tack. Effect of the GABAB agonist baclofen in patients with symptoms and duodeno-gastro-oesophageal reflux refractory to proton pump inhibitors. Gut, 2003; 52: 1397–1402.G. H. Koek, D. Sifrim, T. Lerut, J. Janssens, J. Tack. Effect of the GABAB agonist baclofen in patients with symptoms and duodeno-gastro-oesophageal reflux refractory to proton pump inhibitors. Gut, 2003; 52: 1397–1402.E. Scarpellini, D. Ang, A. Pauwels, A. De Santis, Tim Vanuytsel, J. Tack. Management of refractory typical GERD symptoms. Nature Reviews Gastroenterology & Hepatology, 2016; 13: 281–294.E. Scarpellini, D. Ang, A. Pauwels, A. De Santis, Tim Vanuytsel, J. Tack. Management of refractory typical GERD symptoms. Nature Reviews Gastroenterology & Hepatology, 2016; 13: 281–294.S. Peng et al. In Barrett’s esophagus patients and Barrett’s cell lines, ursodeoxycholic acid increases antioxidant expression and prevents DNA damage by bile acids. Am J Physiol Gastrointest Liver Physiol, 2014; 307: 129–139.S. Peng et al. In Barrett’s esophagus patients and Barrett’s cell lines, ursodeoxycholic acid increases antioxidant expression and prevents DNA damage by bile acids. Am J Physiol Gastrointest Liver Physiol, 2014; 307: 129–139.B. Banerjee et al. Clinical Study of Ursodeoxycholic Acid in Barrett’s Esophagus Patients. Cancer Prev Res (Phila), 2016; 9 (7): 528–533.B. Banerjee et al. Clinical Study of Ursodeoxycholic Acid in Barrett’s Esophagus Patients. Cancer Prev Res (Phila), 2016; 9 (7): 528–533.Мартынов А. И., Шептулин А. А., Маев И. В., Казюлин А. Н., Каратеев А. Е., Мелехов А. В., Пальгова Л. К., Райхельсон К. Л. Новые возможности цитопротекции в лечении и профилактике заболеваний желудка и кишечника (резолюция Экспертного совета и обзор литературы). Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2020; 30 (2): 7–14. https://doi.org/10.22416/1382–4376–2020–30–2–7–147–14.Martynov A. I., Sheptulin A. A., Mayev I. V., Kazyulin A. N., Karateev A. Y., Melekhov A. V., Pal’gova L.K., Raikhel’son K. L. New Prospects of Cytoprotection in the Treatment and Prevention of Gastric and Intestinal Diseases (Resolution of an Expert Council and Literature Review). Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2020; 30 (2): 7–14. (In Russ.)Reimer C. et al. Concentrated Alginate as Add-On Therapy in Gastro-Esophageal Reflux Disease (GERD) Patients with Inadequate Response to Once Daily Proton Pump Inhibitor (PPI): A Multicentre, Randomized, Double-Blind, Placebo-Controlled Pilot Study. Gastroenterology, 2015; 148: 135–136.Reimer C. et al. Concentrated Alginate as Add-On Therapy in Gastro-Esophageal Reflux Disease (GERD) Patients with Inadequate Response to Once Daily Proton Pump Inhibitor (PPI): A Multicentre, Randomized, Double-Blind, Placebo-Controlled Pilot Study. Gastroenterology, 2015; 148: 135–136.Ю. П. Успенский, И. Г. Пахомова, Е. И. Ткаченко. Первый в России опыт использования «Гевискона» в лечении гастроэзофагеальной рефлюксной болезни. Русский медицинский журнал, 2007; 15 (22): 1–4 [Yu. P. Uspensky, I. G. Pakhomova, E. I. Tkachenko. The first experience of using Gaviscon in Russia in the treatment of gastroesophageal reflux disease. Russian Medical Journal, 2007; 15 (22): 1–4].Ю. П. Успенский, И. Г. Пахомова, Е. И. Ткаченко. Первый в России опыт использования «Гевискона» в лечении гастроэзофагеальной рефлюксной болезни. Русский медицинский журнал, 2007; 15 (22): 1–4 [Yu. P. Uspensky, I. G. Pakhomova, E. I. Tkachenko. The first experience of using Gaviscon in Russia in the treatment of gastroesophageal reflux disease. Russian Medical Journal, 2007; 15 (22): 1–4].

The authors declare that there are no conflicts of interest present.