- 期刊
胃上嗝氣與胃食道逆流
Supragastric belching and gastroesophageal reflux disease
摘要
打嗝（hiccup）或嗝氣（belching）是日常生活中的上消化道生理排氣機制，但一旦成為病態且影響生活品質時，就必須要考慮是行為障礙（behavior disorder）所引起的胃上嗝氣（supragastric belching, SGB）。在不當的場合或是長時間的病態嗝氣不僅對患者的生活上帶來困擾，嚴重時甚至可以影響正常飲食、睡眠障礙、體重減輕等，甚至導致患者的情緒、心理健康受到影響，出現包括焦慮、失眠或抑鬱等精神疾患。長期處於高壓的情況下，胃上嗝氣症狀更加惡化，形成一個惡性循環。當患者自覺被嗝氣習慣所擾時，臨床上可以用多管腔食道內阻抗併酸鹼度檢測儀（multi-channel intraluminal impedance-pH monitor, MII-pH）或高解析度食道壓力檢查（high-resolution manometry, HRM）來確立胃上嗝氣的診斷及初步判斷疾病的嚴重程度。若確認為胃上嗝氣的患者，臨床上採取的主要是非藥物治療，包括認知行為治療（cognitive behavior therapy, CBT）及語言治療（speech therapy），不僅對胃上嗝氣症狀有療效，更可以減少食道的酸曝露。胃上嗝氣除了是由行為障礙所引起以外，還可能與其他上消化道疾病的存在有著密切關係，特別是胃食道逆流疾病（gastroesophageal reflux disease, GERD）。許多研究發現在強力抑酸藥物（如質子幫浦抑制劑）治療無效的胃食道逆流患者（PPI-refractory GERD），經常會發現同時存在胃上嗝氣症狀。胃上嗝氣可以導致到胃食道逆流疾病的程度惡化及食道酸酸曝露的時間變長，胃食道逆流亦有可能誘發胃上嗝氣症狀的產生，甚至進一步傷害食道組織及影響食道功能。因此，對於難治型胃食道逆流患者來說，胃上嗝氣可能是發病機制中的一個重要因素，需要儘早查出並加以適當治療。
並列摘要
Belching, a common bothering symptom in our clinical practice, can be further classified into gastric belching and supragastric belching (SGB). The etiology of SGB is primarily related to behavioral disorders or concurrent gastroesophageal reflux disease. According to the updated Rome IV criteria, when belching occurs more than three days a week and causes distress in the patient's daily activities, it is considered to be excessive belching. Diagnosis of SGB relies on multi-channel intraluminal impedance-pH monitoring (MII-pH) or high-resolution manometry (HRM). When the diagnosis of SGB is confirmed, optimal treatment includes non-pharmacological interventions such as cognitive behavior therapy (CBT), speech therapy, and diaphragmatic breathing can be initiated, which not only alleviate symptoms, reduce esophageal acid exposure but also improve quality of life. Pharmacological treatment such as Baclofen, acid suppression or central neuromodulating agents, may also play a supporting role. SGB may induced or exacerbate the severity of gastroesophageal reflux disease (GERD). Patients with proton pump inhibitor (PPI)-refractory GERD often associated with excessive belching, particularly SGB. Therefore, for patients with PPI-refractory GERD, SGB may be an important factor in the pathophysiology, necessitating early detection and appropriate treatment.