cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2018-33-3-22-29cardiotomsk-551Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESСОВРЕМЕННЫЕ ПРЕДСТАВЛЕНИЯ О ПАТОГЕНЕЗЕ ИЗЖОГИMODERN CONCEPTS OF HEARTBURN PATHOGENESISБарановС. А.BaranovS. A.

канд. мед. наук, доцент кафедры пропедевтики внутренних болезней лечебного факультета

119435, Российская Федерация, Москва, ул. Погодинская, 1, стр. 1

Cand. Sci. (Med.), Lecturer, the Chair of Internal Diseases Propedeutics

1, building 1, Pogodinskaya str., Moscow, 119435, Russian Federation

brunhild1958@mail.ruШульпековаЮ. О.Shul’pekovaYu. O.

анд. мед. наук, доцент кафедры пропедевтики внутренних болезней лечебного факультета

119435, Российская Федерация, Москва, ул. Погодинская, 1, стр. 1

Cand. Sci. (Med.), Lecturer, the Chair of Internal Diseases Propedeutics

1, building 1, Pogodinskaya str., Moscow, 119435, Russian Federation

jshulpekova@gmail.comНечаевВ. М.NechaevV. M.

канд. мед. наук, доцент кафедры пропедевтики внутренних болезней лечебного факультета

119435, Российская Федерация, Москва, ул. Погодинская, 1, стр. 1

Cand. Sci. (Med.), Lecturer, the Chair of Internal Diseases Propedeutics

1, building 1, Pogodinskaya str., Moscow, 119435, Russian Federation

brunhild1958@mail.ruПервый Московский государственный медицинский университет им. И. М. Сеченова (Сеченовский университет)РоссияI. M. Sechenov First Moscow State Medical UniversityRussian Federation2018261120183332229Copyright © Баранов С.А., Шульпекова Ю.О., Нечаев В.М., 20182018Баранов С.А., Шульпекова Ю.О., Нечаев В.М.Baranov S.A., Shul’pekova Y.O., Nechaev V.M.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/551

Изжога — один из наиболее частых симптомов и особенно распространена в экономически развитых западных странах. Согласно классическим представлениям, в основе ее возникновения лежит активация хемо- и механо-рецепторов первичных сенсорных нейронов пищевода. Однако при воздействии повторных раздражителей возможно формирование сенситизации. Ее развитию способствует влияние стрессового гормона кортикотропин-рилизинг-фактора. Для более четкой дифференциации изжоги как проявления гастроэзофагеальной рефлюксной болезни или заболевания функционального характера необходим внимательный анализ этого симптома с оценкой провоцирующих факторов, эффекта различных препаратов. Отсутствие ответа на терапию ингибиторами протонной помпы — важный опорный критерий для обоснованного подозрения на наличие функциональной патологии пищевода, хотя сенситизация играет важную роль в развитии изжоги также при неэрозивной гастроэзофагеальной рефлюксной болезни. Для дифференциальной диагностики в случаях рефрактерной и «эндоскопически негативной изжоги» показано проведение дополнительных исследований: эндоскопии с биопсией пищевода, суточной рН-метрии/рН-импедансометрии, манометрии высокого разрешения. Ингибиторы протонной помпы, высокоэффективные при гастроэзофагеальной рефлюксной болезни, могут помочь лишь в отдельных случаях функциональной изжоги и гиперсенситивности к рефлюксу; в этих случаях в качестве средств эмпирической терапии применяются препараты, влияющие на висцеральную гиперчувствительность.

Heartburn is one of the most widely spread symptoms particularly in population of economically developed Western countries. Traditionally it is considered to be related to activation of chemo- and mechanoreceptors of esophageal primary sensory neurons. Repeated stimulation may provoke visceral sensitization. Its development is facilitated by the stress hormone corticotropin-releasing factor. An attentive analysis of heartburn with an assessment of the provoking factors and effectiveness of drug therapy is required for differentiation of gastro-intestinal reflux disease and functional esophageal disease. The lack of response to proton pump inhibitors is an important criterion for suspicion on functional esophageal pathology although sensitization also plays an important role in genesis of heartburn in non-erosive reflux disease. In cases of refractory and «endoscopically negative heartburn», additional studies are justified: endoscopy with esophageal biopsies, 24h-pH-metry/pH-impedansometry, high-resolution manometry. Proton pump inhibitors, highly effective in reflux disease, may relieve heartburn only in some cases of functional heartburn and reflux hypersensitivity. In functional diseases medical therapy affecting visceral hypersensitivity may be used empirically.

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