胃酸倒流不止「火燒心」 嚴重可增食道癌風險

胃酸倒流(又稱胃食道逆流)是指胃液由胃部倒流至食道的情況,最常見的症狀就是俗稱「火燒心」的心口痛或胸口灼痛,通常發生在進食之後的時間。雖然間中出現以上情況是非常普遍而且正常的事,但如果胃液經常倒流,每星期發生兩次或以上,就有機會是影響健康的「胃食道反流疾病」。1

2002年至2011年間,

港人患胃酸倒流的比率

相對升幅達50%2

亞洲人患胃酸倒流的機會較歐美人士低;

警覺性亦較低,

有70%-96%患者未有求醫。3-5

胃酸倒流成因

有不少人誤以為胃酸倒流只是吃太飽或一時胃酸過多的個別情況,而輕視當中的嚴重性。然而,若發生次數較頻密,或症狀已影響日常生活,則不應大意,因為身體的食道括約肌功能或已出現異常。

我們的食道和胃之間有一組肌肉—食道括約肌,它就像一對活門,在進食時打開讓食物到達胃部。其餘時間它都會關閉,阻止胃部分泌物倒流;當它在不適當的時候鬆弛,胃酸便有機會倒流並刺激食道。6

造成食道括約肌功能異常的原因

  • 食道裂孔疝氣:因食道周圍的肌肉退化,或腹壓過高而令食道裂孔功能受損,胃向胸腔擠壓,令食道括約肌受損。7
  • 肥胖:使腹內壓力增加,減慢胃排空時間,令食道下括約肌減壓,暫時性鬆弛頻率變密。而且肥胖也會增加患上食道裂孔疝氣的風險。8
  • 懷孕:造成黃體素分泌和腹部壓力增加,使孕婦的食道括約肌較容易鬆馳。6,9

其他造成胃酸倒流或令病情惡化的原因

  • 胃部疾病:胃排空減緩、胃輕癱問題令食物留在胃部的時間較長,增加胃和食道之間的壓力差和胃酸分泌。10
  • 飲食習慣:如經常飲咖啡、酒精類、碳酸類等刺激性飲品;進食高熱量、油膩、酸性或辛辣食物,如朱古力、煎炸食品、醋和辣椒等。進食的份量、時間也有影響。7,11
  • 生活習慣:吸煙;或長期感到焦慮和壓力大的人士都有較大風險。11
  • 藥物副作用:如消炎止痛藥布洛芬有機會造成胃酸倒流。7
  • 哮喘患者患上胃酸倒流的機會較高,且通常在確診哮喘後的一年內發生12

胃酸倒流症狀

胃酸倒流的常見症狀

  • 火燒心(胸腔灼痛)13-14
  • 胃液倒流湧上食道,甚至口腔內嚐到酸味13-14
  • 吞嚥困難14
  • 喉嚨有異物感14

胃酸倒流的其他症狀

  • 持續咳嗽、打嗝13
  • 口乾15
  • 口氣13
  • 肚漲13
  • 聲音沙啞13
  • 注意: 胃酸倒流的症狀或與其他上食道疾病的症狀重疊16
  • 胃酸倒流的併發症17
    • 糜爛性食道炎
    • 食道收窄
    • 巴洛氏食道症 (癌前病變)
    • 食道腺癌
    • 肺病

胃酸倒流診斷

胃酸倒流的測試

  • 質子泵抑制劑測試 (PPI trial)
    • 接受兩星期、每日40毫克的質子泵抑制劑,若主要症狀消失,代表可能患上了胃酸倒流。部分醫生或會在此之前先安排安慰劑測試。18
  • 食道酸鹼值監測
    • 將監測器置入食道下端,檢查24小時,若酸鹼值少於4.0,即有胃酸倒流的情況。過往需用鼻導管置入和連接監測器,造成患者不適及不便。如今普遍改用Bravo酸鹼度測量系統(Bravo capsule )。19
  • 上消化道內窺鏡
    • 最準確的檢查方法,甚至可做切片檢查,排除其他造成相似症狀的病因。20

香港中文大學認可的「GERD-Q胃酸倒流症狀問卷」可初步評估患胃酸倒流的風險21

胃酸倒流治療11

胃酸倒流是一種慢性疾病,治療過程相對長,也需要改善日常生活習慣,包括:

  • 改變飲食習慣,減少及避免過量飲酒,戒煙。避免食份量過大的晚餐或食宵夜,以及減少脂肪攝取量。
  • 建議過重的患者減肥,控制體重。
  • 有研究發現,往左側睡有助減輕症狀22;若仰卧則可將頭部墊高6吋。23

胃酸倒流的藥物治療

除了改變生活習慣,也可分別透過三種主要藥物治療來抑制胃酸,分別是:

制酸劑24

  • 旨在數分鐘內中和胃酸,患者須於症狀開始或預料將會出現時服食
  • 藥力來得快,去得快,但沒有長期療效
  • 只有四分一患者接受制酸劑後得以紓緩症狀

H2受體阻抗劑(H2RAs)

  •  較制酸劑更有效紓患者的症狀24
  • 首款可治療由胃酸倒流引起的中度糜爛性食道炎的藥物25
  • 不足以治療較嚴重的糜爛性食道炎25
  • 恆常服用會出現快速抗藥反應(tachyphylaxis)25
  • 雖然其抑制胃酸的藥效不及PPIs,但由於有機會抑制晚間因組織胺而分泌的胃酸,醫生或會為正接受PPIs治療、且有夜間酸突破問題的病人加開H2Ras25

質子泵抑制劑 (PPIs)

  • 為目前被認為最好的方案25
  • 數個試驗反映它在紓緩症狀、治療黏膜、糜爛性食道炎上的療效較H2RAs顯著24-25
    • 83%患者的症狀得以紓緩
    • 78%患上糜爛性食道炎的患者對治療有反應
  • 能日夜長期和穩定地抑制胃酸25
  • 配合健康的飲食習慣,有助治療發揮最大作用26
  • 若患者未有定時用藥,PPIs治療在控制餐後胃酸倒流的成效會減弱。26

參考資料

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  7. Clinical Gastroenterology and Hepatology.(2018) ,16( 5) A27-A27.
  8. Hampel, H., Abraham, N. S., & El-Serag, H. B. (2005). Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Annals of internal medicine, 143(3), 199–211.
  9. Indigestion and heartburn in pregnancy. (27 November 2017). Retrieved September 11, 2020, from https://www.nhs.uk/conditions/pregnancy-and-baby/indigestion-heartburn-pregnant/
  10. Fass, Ronnie, McCallum, Richard W, and Parkman, Henry P. 「Treatment Challenges in the Management of Gastroparesis-Related GERD.」 Gastroenterology & Hepatology 5.10 Suppl 18 (2009): 4-16.
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HK-4457 10/14/2020