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

doi:10.3892/etm.2023.12113

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

Authors:
- Fei Yu
- Yue Zhu
- Na Li
- Hong-Fang Fu
- Zhi Jiang
- Xiao-Yi Zhang
- Liang Zeng
- Xiao-Yu Hu
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Affiliations: Department of Infectious Diseases, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610072, P.R. China
Published online on: July 12, 2023 https://doi.org/10.3892/etm.2023.12113
Article Number: 414
Copyright: © Yu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

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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