莫沙必利联合质子泵抑制剂治疗胃食管反流病的Meta分析

目的 评价莫沙必利治疗胃食管反流病(GERD)的有效性和安全性。方法 检索Pub Med、EMBase、中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普信息资源系统(VIP)、万方数据库,从建库至2013年6月,所有莫沙必利联合质子泵抑制剂(PPI)治疗胃食管反流病的随机对照试验。用Cochrane系统评价方法评价后,用Rev Man 5.2软件进行Meta分析。结果 共纳入32项研究(2918例患者),治疗组(莫沙必利联合质子泵抑制剂)对GERD临床症状缓解率[OR=4.54,95%CI(3.59,5.75),P<0.01]以及对内镜下胃食管炎症应答率[OR=4.37,95%CI(3.08,6.21),P<0.01]均高于对照组(单用质子泵抑制剂)。治疗组不良反应发生数[OR=1.06,95%CI(0.74,1.53),P>0.05],与对照组比较差异无统计学意义。结论 试验组对胃食管反流病的治疗效果优于对照组,安全性与对照组差异无统计学意义。     

兰索拉唑治疗胃食管反流病临床疗效的Meta分析

目的 系统评价兰索拉唑与其它质子泵抑制剂治疗胃食管反流病(GERD)的临床疗效,为临床用药提供参考。方法 计算机检索中国期刊全文数据库(CNKI)、万方、维普、Pub Med、Medline、Cochrane Library数据库,收集国内外已公开发表的比较兰索拉唑和其它质子泵抑制剂治疗胃食管反流病疗效的随机对照试验(RCT),以临床症状缓解率和内镜下治愈率为评价指标,采用Cochrane协作网提供的Meta分析软件Rev Man5.0进行数据的处理与分析。结果 最终共纳入中文RCT 13篇,英文RCT 6篇,合计9143例患者,Meta分析结果显示:兰索拉唑与奥美拉唑[OR=0.71,95%CI(0.33,1.54),P>0.05]、雷贝拉唑[OR=0.59,95%CI(0.26,1.37),P>0.05]临床症状缓解率相当,但不及埃索美拉唑[OR=0.38,95%CI(0.24,0.62),P<0.05],仅一篇文献比较了与泮托拉唑临床症状缓解率,结果无统计学差异;兰索拉唑与奥美拉唑[OR=1.08,95%CI(0.86,1.35),P>0.05]、泮托拉唑[OR=0.72,95%CI(0.44,1.16),P>0.05]内镜下治愈率相当,但不及雷贝拉唑[OR=0.44,95%CI(0.22,0.85),P<0.05]、埃索美拉唑[OR=0.48,95%CI(0.33,0.70),P<0.05]。结论 在治疗胃食管反流病时,兰索拉唑与奥美拉唑、泮托拉唑疗效相当,不及埃索美拉唑、雷贝拉唑,但该结论仍需大规模多中心研究进一步证实。     

伏诺拉生治疗胃食管反流有效性和安全性的Meta分析

目的 评价伏诺拉生治疗胃食管反流（GERD）的有效性和安全性,为临床用药提供循证依据。方法 计算机检索PubMed、the Cochrane Library、Web of Science、中国知网、万方数据、维普网和中国生物医学文献数据库,收集伏诺拉生（试验组）对比安慰剂或质子泵抑制剂（对照组）的随机对照试验（RCT）,检索时限为建库起至2022年6月。筛选文献、提取资料后采用Cochrane系统评价员手册5.1.0推荐的偏倚评估工具对纳入文献质量进行评价;采用RevMan 5.4软件进行Meta分析、敏感性分析和发表偏倚分析。结果 共纳入9项RCT,共计1 882例患者。Meta分析结果显示,试验组患者的总体有效率[OR=1.94,95%CI(1.45,2.58),P<0.000 01]、治愈率[OR=2.27,95%CI(1.33,3.86),P=0.003]、缓解率[OR=1.81,95%CI(1.28,2.55),P=0.000 7]均显著高于对照组;两组患者的药物不良事件发生率及腹泻、鼻咽炎、上呼吸道感染、碱性磷酸酶升高发生率比较,差异均无统计学意义（P>0.05...     

艾司奥美拉唑治疗胃-食管反流病的荟萃分析

目的：运用荟萃分析对艾司奥美拉唑治疗胃-食管反流病的治愈率和症状缓解率进行评价。方法：检索中国生物医学文摘数据库(CBM),MEDLINE和Cochrane图书馆等数据库,收集2000～2005年有关艾司奥美拉唑对胃-食管反流病的治疗作用的随机对照临床试验,应用Review Manager 4．1(版)软件进行统计分析。结果：艾司奥美拉唑对反流性食管炎病人的治愈率显著高于其他质子泵抑制剂[相对危险度(RR)=1．06；95％CI=(1．04,1．09)；P<0．000 01]；艾司奥美拉唑对胃-食管反流性疾病病人的症状缓解率显著高于其他质子泵抑制剂[RR=1．07；95％CI=(1．05,1．10)；P<0．000 01]。结论：艾司奥美拉唑对胃-食管反流病的治疗作用优于其他质子泵抑制剂。     

雷贝拉唑或奥美拉唑联合莫沙必利治疗反流性食管炎有效性和安全性的meta分析

目的:评价雷贝拉唑或奥美拉唑联合莫沙必利治疗反流性食管炎的疗效和安全性.方法:计算机检索Pubmed、Cochrane Library、Medline、Embase、中国知网(CNKI)、万方等数据库,收集比较雷贝拉唑或奥美拉唑联合莫沙必利治疗反流性食管炎的随机对照试验研究,进行质量评价、数据提取、偏倚评估,用RevMan 5.3软件进行数据分析.结果:纳入11项研究,共1000例患者.治疗8周后,雷贝拉唑组症状观察有效率和内镜观察有效率均高于奥美拉唑组[OR=4.43,95%CI(2.72,7.22),P<0.00001;OR=3.15,95%CI(2.16,4.60),P<0.00001];两组间不良反应发生率差异无统计学意义[OR=0.74,95%CI(0.37,1.47),P=0.39].结论:较之奥美拉唑,雷贝拉唑联合莫沙必利治疗具有症状消失快,临床症状和电镜评估疗效有效率高等优点,是治疗反流性食管炎较好的临床选择,值得推广应用.     

质子泵抑制剂联合康复新液对比质子泵抑制剂单药治疗反流性食管炎的Meta分析

目的观察质子泵抑制剂联合康复新液对比质子泵抑制剂单药治疗反流性食管炎的Meta分析。方法运用计算机对The Cochrane Library、Pub Med、Embase、中国期刊全文数据库以及维普中文科技期全文数据库进行检索,采用Stata 12.0软件对数据进行Meta分析,对国内外符合关于质子泵抑制剂联合康复新液治疗反流性食管炎的临床效果标准的随机对照试验进行定量综合分析。结果本分析共纳入5个符合标准的随机对照试验,其中患者共346例,通过分析发现质子泵抑制剂联合康复新液进行治疗的总有效率[OR=4.90,95%CI(2.27,10.61),P<0.0001],治疗效果明显优于单独使用质子泵抑制剂单药治疗。结论通过对数据的分析以及研究可以发现,采用质子泵抑制剂联合康复新液对反流性食管炎的治疗效果相对于使用质子泵抑制剂单药进行治疗效果明显且不良反应小,效果较好。但是进行研究的数据受到各方面因素的影响,需要进一步深入研究。     

莫沙必利对比质子泵抑制剂治疗功能性消化不良疗效与安全性的系统评价

目的:系统评价莫沙必利对比质子泵抑制剂(PPI)治疗功能性消化不良(FD)的疗效和安全性,以为临床治疗提供循证参考。方法:计算机检索Pub Med、EMBase、Medline、Cochrane图书馆、中国期刊全文数据库、万方数据库,纳入莫沙必利(试验组)对比PPI(对照组)治疗FD的随机对照试验(RCT),提取资料并评价质量后,采用Rev Man 5.2统计软件进行Meta分析。结果:共纳入12项RCT,合计1 750例患者。Meta分析结果显示,试验组患者总缓解率[OR=0.56,95%CI(0.45,0.70),P<0.000]、反酸缓解率[MD=0.63,95%CI(0.50,0.75),P<0.000]、腹痛缓解率[MD=0.65,95%CI(0.57,0.80),P<0.000]均显著低于对照组,而腹胀缓解率[MD=-0.01,95%CI(-0.18,0.16),P=0.91]、不良反应发生率[OR=1.83,95%CI(0.73,4.59),P=0.19]与对照组比较差异无统计学意义。结论:PPI治疗FD的疗效优于莫沙必利,安全性相当。由于受纳入研究样本量的限制及文献质量的影响,该结论有待大样本、高质量的RCT进一步验证。     

氟哌噻吨美利曲辛片辅助治疗难治性胃食管反流病的Meta分析

目的 系统评价氟哌噻吨美利曲辛片联合常规药物治疗难治性胃食管反流病（refractory gastroesophageal refluxdisease,RGERD）的疗效和安全性。方法 采用Cochrane系统评价方法,检索Pubmed、CNKI、CBM、万方数据库。检索从建库至2016年1月,氟哌噻吨美利曲辛片联合常规药物治疗难治性胃食管反流病的随机对照试验（RCT）,对符合纳入标准的临床实验研究进行质量评价和资料提取后,采用RevMan 5.2进行Meta分析。结果 共纳入9个研究共计1 004例患者,Meta分析结果显示,与对照组（常规药物）相比,试验组（氟哌噻吨美利曲辛片联合常规药物）对难治性胃食管症状应答更显著[OR=5.41,95% CI=（3.20,9.14）,P<0.000 01],6个研究评价了治疗4周后的症状缓解有效率,结果实验组明显优于对照组[OR=6.18,95% CI=（2.99,12.76）,P<0.000 01],3个研究评价了治疗8周后症状缓解有效率,结果显示实验组优于对照组[OR=3.96,95% CI=（2.18,7.21）,P<0.000 01],5个研究均采用汉密尔顿抑郁量表（Hamilton DepressionScale,HAMD）和汉密尔顿焦虑量表（Hamilton Anxiety Scale,HAMA）评价治疗期末抑郁和焦虑的改善,Meta分析结果显示,实验组对抑郁和焦虑的改善程度均优于对照组,差异有统计学意义（HAMD：SMD=-2.04,95% CI=（-2.98,-1.11）,P<0.000 1;HAMA：SMD=-1.23,95% CI=（-1.47,-1.00）,P<0.000 01）;5个试验报道了治疗过程中的不良反应,分析结果显示,2组差异无统计学意义（OR=1.65,95% CI=（0.76,3.59）,P=0.21）,且症状均较轻微,可耐受。结论 分析结果显示,氟哌噻吨美利曲辛片联合常规药物治疗难治性胃食管反流病相对常规药物疗效更显著,且不良反应无明显差异,但该结论仍需大规模多中心研究进一步证实。     

质子泵抑制剂联合莫沙必利治疗胃食管反流病的临床分析

目的：研究分析质子泵抑制剂联合莫沙必利治疗胃食管反流病的临床效果。方法选取2013年～2015年经我院诊断并治疗的胃食管反流病患者120例作为研究对象,采用随机数字表法将上述患者随机分为联合治疗组和单一治疗组,其中联合治疗组60例,单一治疗组60例。单一治疗组给与予患者莫沙必利治疗,联合治疗组在单一治疗组的基础上给予患者质子泵抑制剂治疗,治疗2个月之后,分别记录两组患者的治疗效果,并比较。结果联合治疗组总有效率为93．34％,单一治疗组总有效率为80．00％,联合治疗组总有效率明显优于单一治疗组。 P＜0．05,具有统计学意义。结论质子泵抑制剂联合莫沙必利治疗胃食管反流病临床效果显著,值得临床应用及推广。     

奥美拉唑与兰索拉唑治疗胃食管反流病效果的meta分析

目的 系统性评价奥美拉唑、兰索拉唑治疗胃食管反流病的临床疗效,为胃食管反流病临床治疗方案选择提供数据支持。方法 依据胃食管反流病、奥美拉唑以及兰索拉唑等主题,检索知网、万方、PubMed、维普、龙源等数据库,筛选并最终纳入文献12篇。其中,观察组采用口服兰索拉唑缓释胶囊治疗,对照组采用口服奥美拉唑肠溶胶囊治疗,对总有效率、不良反应发生率、症状缓解情况、胃镜下愈合率4项指标作系统性分析。结果 观察组总有效率明显高于对照组,差异具有统计学意义(OR=7.09,95%CI:3.48～14.46,Z=5.39,P<0.000 01);观察组不良反应发生率明显低于对照组,差异具有统计学意义(OR=0.31,95%CI:0.19～0.50,Z=4.83,P<0.000 01);观察组症状缓解情况明显优于对照组,差异具有统计学意义(OR=3.64,95%CI:1.97～6.74,Z=4.11,P<0.000 01);观察组胃镜下愈合率明显高于对照组,差异具有统计学意义(OR=2.66,95%CI:1.66～4.25,Z=4.09,P<0.000 01)。结论 相较于奥美拉唑,...     

Systematic review: maintenance treatment of gastro-oesophageal reflux disease with proton pump inhibitors taken 'on-demand'

BACKGROUND: Proton pump inhibitors (PPI) therapy 'on-demand' is often used as an alternative to continuous maintenance therapy in gastro-oesophageal reflux disease (GERD). AIM: We conducted a systematic review with the specific objectives to ascertain whether on-demand PPI therapy was effective in preventing symptomatic relapse and to assess the relative efficacy of on-demand vs. continuous PPI maintenance strategy. METHODS: Randomized-controlled clinical trials comparing on-demand PPI vs. placebo or on-demand vs. continuous PPI therapy in GERD patients were identified by searching the Medline database and the Cochrane Controlled Trials Register. RESULTS: Seventeen studies were found which met inclusion criteria. Out of the 17 studies: five investigated exclusively patients with non-erosive reflux disease (NERD), four patients with NERD and mild oesophagitis, two patients with erosive oesophagitis only, and two patients with uninvestigated GERD symptoms, respectively. Four further studies were not investigating the effectiveness of the therapies but primarily pharmacoeconomic or quality of life parameters. CONCLUSIONS: On the basis of the analysis of 17 studies, we can conclude that on-demand therapy with currently available PPI appears to be effective in the long-term management of patients with NERD or mild and uninvestigated forms of GERD, but not in patients with (severe) erosive oesophagitis.     

埃索美拉唑联合莫沙比利治疗反流性食管炎的临床研究

目的：评价埃索美拉唑联合莫沙比利治疗反流性食管炎安全性、有效性。方法2013年5月~2015年5月,观察组与对照组各入选40例GERD,分别采用埃索美拉唑联合莫沙必利、单独应用莫沙必利治疗,对比疗效、不良反应发生例。结果观察组痊愈率42.5%、愈显率92.5%高于对照组22.5%、60.0%,差异具有统计学意义（P<0.05）;对照组未见不良反应,观察组出现1例骨质疏松症、1例胸痛,差异无统计学意义（P>0.05）。结论埃索美拉唑联合莫沙必利治疗GERD疗效较好,安全可靠。     

句橼酸莫沙必利联合埃索美拉唑治疗胃食管反流病临床疗效观察

目的观察枸橼酸莫沙必利联合埃索美拉唑治疗胃食管反流病（GERD）的临床疗效,总结其治疗经验。方法选择2010年8月～2012年8月本院收治的GERD患者120例,依据随机对照原则分为观察组（60例）与对照组（60例）,观察组采用枸橼酸莫沙必利联合埃索美拉唑进行治疗,对照组采用埃索美拉唑治疗,分别在治疗4周及8周后复查消化内镜,同时观察临床症状的改善情况。结果两组患者均顺利完成治疗,无严重不良反应发生,治疗4周及治疗8周后观察组的总有效率均高于对照组,其差异具有统计学意义（P〈0．05）。结论枸橼酸莫沙必利联合埃索美拉唑对于治疗GERD具有较好的临床疗效,同时不良反应少,值得临床推广应用。     

兰索拉唑法莫替丁和莫沙比利联合治疗反流性食管炎

目的观察兰索拉唑、法莫替丁和莫沙比利联合治疗反流性食管炎的临床疗效。方法46例反流性食管炎随机接受兰索拉唑、法莫替丁和莫沙比利联合治疗或仅服用雷尼替丁治疗。4周后观察临床症状,并经胃镜检查观察食管炎变化。结果经4周治疗发现,联合治疗组患者明显改善临床症状、如反酸、心、胸骨后疼痛等。食管炎症分级也有明显降低(P<0.05)。结论兰索拉唑、法莫替丁和莫沙比利联合应用有效地控制胃酸和胆汁的反流,是治疗反流性食管炎的一种有效、价廉的方法。     

Evolving drugs in gastroesophageal reflux disease: pharmacologic treatment beyond proton pump inhibitors

Importance of the field: Despite the clinical success of proton pump inhibitors to treat gastroesophageal reflux disease (GERD), for the majority of patients in both gastroenterology and primary care clinics there is still a substantial group of patients (up to 40% in some studies) who do not completely respond symptomatically to a standard dose of proton pump inhibitors (PPIs). Specific explanations for these PPI noncomplete responders included transient lower esophageal sphincter relaxations (TLESRs), sensitivity to weakly acidic and/or alkaline reflux, large volume of reflux and esophageal hypersensitivity. There is a clear need for GERD therapies beyond the PPIs.

Areas covered in this review: These drug classes include the GABA_B receptor agonists (including lesogaberan and arbaclofen placarbil), mGluR5 receptor antagonists, P-CABs, cholecystokinin₂ antagonists and add-on therapies to PPIs including mosapride and rikkunshito.

What the reader will gain: Both physicians and patients are eagerly awaiting the development and FDA approval of a new class of anti-GERD medications targeting distinct mechanisms. This article provides information on pharmacologic strategies, clinical trials and side-effect profiles on several of the most promising and heavily researched compounds being developed today for the treatment of GERD symptoms and inflammation. Hopefully, this important research will help a large group of PPI noncomplete responding patients receive symptomatic relief and reduce esophageal inflammation through a unique pharmacologic mechanism in the near future.

Take home message: The treatment of GERD has greatly improved with the PPI class of therapy. Despite excellent success, there is a sizeable population of patients who do not have adequate response to therapies directed only at acid suppression. Emerging new pharmacologic treatment options show promise in further advancing the treatment success of GERD.     

胃食管反流病三种治疗方案的对比性观察

目的 研究埃索美拉唑、莫沙比利、铝碳酸镁治疗胃食管反流病（GERD）的疗效,寻找有效治疗方法.方法 90例初诊为GERD患者按随机数字表法分为A组（30例）、B组（30例）、C组（30例）三组,A组埃索美拉唑40 mg,1次/d.B组埃索美拉唑40 mg,1次/d;莫沙比利5 mg,3次/d.C组埃索美拉唑40 mg,1次/d;莫沙比利5mg,3次/d;铝碳酸镁1.0g,3次/d.治疗4周及治疗8周评价症状缓解情况.结果 治疗4周后A组、B组、C组临床症状缓解率分别为66.7％、83.3％和90.0％,治疗8周后A组、B组、C组临床症状缓解率分别为73.3％、90.0％和96.7％,治疗8周时A组与C组总有效率相比差异有统计学意义（P＜0.05）,A组与B组、B组与C组差异均无统计学意义（P＞0.05）.结论 埃索美拉唑联合莫沙比利、铝碳酸镁治疗GERD可获得较好疗效,提高症状缓解率.     

Non-erosive reflux disease and atypical gastro-oesophageal reflux disease manifestations: treatment results

Gastro-oesophageal reflux disease (GERD) is a widespread complex disorder that may be responsible for a variety of different symptoms and clinical features. Despite the presence of symptoms, the majority of patients do not have endoscopic lesions of oesophagitis. Non-erosive reflux disease (NERD) is a chronic, relapsing condition that can adversely affect the quality of life despite the absence of mucosal breaks at endoscopy. In many patients GERD is associated with extra-oesophageal or atypical manifestations, including cough, asthma, laryngitis or non-cardiac chest pain. Acid suppression with proton pump inhibitors (PPI) remains the mainstay of GERD therapy. However, patients with NERD and extra-oesophageal manifestations are often poorly responsive to PPI therapy. Accurate diagnosis followed by adequate PPI dosage and compliance with therapy are essential for the successful control of NERD and extra-oesophageal manifestations. The better detection and characterization of acid and non-acid reflux episodes using developing technologies, such as combined pH-impedance monitoring, is extending our understanding of the pathophysiology of NERD and the extra-oesophageal manifestations of GERD, and will lead to the improved management of these often poorly responsive conditions. This article reviews the treatment results and outlines approaches to the evaluation, diagnosis and therapy of NERD and atypical GERD manifestations.     

埃索美拉唑治疗胃食管反流病的系统评价

目的：评价埃索美拉唑与其它质子泵抑制剂（PPI）比较治疗胃食管反流病的疗效。方法：文献检索并收集埃索美拉唑与其它PPI相比较的随机对照试验文献，按Cochrane协作网提供的方法对纳入文献进行质量评价。结果：共纳入14个随机对照研究（RCT）。对于非糜烂性食管炎埃索美拉唑与潘索拉唑比较在6个月后症状缓解率差异有统计学意义。对于糜烂性食管炎，埃索美拉唑与其他PPI比较均有统计学意义。结论：对于非糜烂性食管炎，埃索美拉唑比潘索拉唑疗效好；对于糜烂性食管炎，埃索美拉唑比其他PPI疗效好。     

The influence of co-morbid IBS and psychological distress on outcomes and quality of life following PPI therapy in patients with gastro-oesophageal reflux disease

Background  A subset of patients with gastro-oesophageal reflux disease (GERD) does not achieve complete symptom resolution with proton pump inhibitor (PPI) therapy. The factors which affect response to PPI therapy in GERD patients remain unclear.
Aims  To determine the prevalence and impact of irritable bowel syndrome (IBS) and psychological distress (PD) on GERD symptoms and disease-specific quality of life (QoL) before and after PPI therapy and to assess the same outcomes before and after PPI therapy in non-erosive reflux disease (NERD) and erosive oesophagitis (EO) GERD patients.
Methods  Patients undergoing oesophago-gastroduodenoscopy (OGD) for heartburn were recruited. Participants completed validated surveys: Digestive Health Symptom Index, Reflux Disease Questionnaire, Quality of Life in Reflux and Dyspepsia and Brief Symptom Inventory (BSI). IBS was defined as >3 Manning criteria and PD as BSI score >63. At OGD, patients were classified as NERD or EO. Patients were treated with rabeprazole 20 mg/day for 8 weeks before completing follow-up surveys.
Results  Of 132 GERD patients enrolled, 101 completed the study. The prevalence rates of IBS and PD were 36% and 41%, respectively. IBS independently predicted worse QoL before and after PPI therapy. PD independently predicted worse GERD symptoms and QoL before and after PPI therapy. There were no differences in symptoms or QoL between NERD and EO patients before or after PPI therapy.
Conclusions  IBS and PD impacted GERD symptoms and QoL before and after PPI therapy. Symptoms and QoL before and after PPI therapy were similar in NERD and EO patients.     

埃索美拉唑、铝碳酸镁和莫沙必利治疗胃食管反流病60例分析

目的探讨埃索美拉唑、铝碳酸镁和莫沙必利治疗胃食管反流病（GERD）的疗效。方法60例GERD患者,给予埃索美拉唑20mg每天2次,铝碳酸镁1.0g,每天3次,莫沙必利5mg每天3次口服。治疗后2、4、6周观察胃烧灼感、反流、泛酸、非心源性胸痛等症状的缓解情况,并于6周后复查胃镜,观察食管炎治愈率。结果治疗2、4、6周后总有效率分别为78.33%、85.00%、93.33%,治疗6周后内镜下A、B、C-D级食管炎治愈率分别达89.28%、80.76%、66.67%,与治疗前比较差异有统计学意义（P〈0.05）。结论埃索美拉唑、铝碳酸镁和莫沙必利是治疗胃食管反流病的有效方案。