奥美拉唑联合莫沙必利治疗反流性食管炎57例临床疗效分析

反流性食管炎(RE)是由于胃和(或)十二指肠内容物,主要是酸性胃液或酸性胃液加胆汁反流至食管所引起的食管黏膜急、慢性炎症性改变,临床主要表现为反酸、烧心、胸骨后烧灼痛等症状[1].质子泵抑制剂是目前治疗RE的一线药物,奥美拉唑是临床上常用的质子泵抑制剂[2].我院近年来采用奥美拉唑联合莫沙必利治疗RE取得了较好的临床疗效,现报道如下.     

奥美拉唑联合法莫替丁治疗反流性食管炎的临床分析

目的探讨奥美拉唑联合法莫替丁治疗反流性食管炎的疗效。方法收集2010年2月至2013年2月我院诊断为反流性食管炎的83例患者为研究对象,将其随机分为研究组和对照组,每组43例。研究组接受奥美拉唑联合法莫替丁治疗,对照组接受奥美拉唑治疗,两组治疗前和治疗后食管黏膜破损分级及反流性食管炎治疗有效率。结果两组治疗前食管黏膜破损分级差异无统计学意义(P>0.05);两组治疗后食管黏膜破损分级差异有统计学意义(P<0.05);两组间反流性食管炎治疗有效率分别为97.7%、88.4%,研究组的有效率明显高于对照组,具有统计学意义(P<0.05)。结论本次研究认为奥美拉唑联合法莫替丁能明显改善反流性食管炎患者临床症状,有利于胃黏膜的修复,具有很好的疗效,值得临床推广使用。     

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。     

奥美拉唑联用西沙必利治疗反流性食管炎疗效分析

目的 研究质子泵抑制剂奥美拉唑联合胃动力药西沙必利对反流性食管炎的治疗作用.方法 74例反流性食管炎患者采用随机方法分成两组,每组37例,治疗组应用奥美拉唑20 mg口服2次/d,西沙必利5mg口服3次/d.对照组西沙必利5mg口服3次/d.治疗4周后观察临床症状消失率及治愈率.结果 讨论奥美拉唑和西沙必利,对照组单用西沙必利,观察治疗前后患者的临床症状改善和内镜变化.结果治疗4周,治疗组与对照组的症状消失有效率分别为98％、55％ (P ＜0.05).内镜复查治疗组、对照组食管黏膜病损愈合总有效率分别为82.3％和54.2％,两组比较差异有统计学意义(P＜0.05).结论 尽管反流性食管炎的主要病因为动力障碍,但其主要的治疗方法仍为抑制胃酸的分泌,奥美拉唑与西沙必利联合治疗对其有明显的疗效.联合用药临床疗效优于单用西沙必利.     

埃索美拉唑联合莫沙必利治疗反流性食管炎的临床疗效观察

目的观察埃索美拉唑联合莫沙必利治疗反流性食管炎的临床疗效和安全性。方法将100例反流性食管炎患者随机分为治疗组和对照组各50例,治疗组给予莫沙必利加埃索美拉唑治疗;对照组给予莫沙必利加奥美拉唑治疗。8周后将两组患者的临床综合疗效、内镜复查食管黏膜愈合情况及不良反应进行比较。结果治疗组的临床综合疗效、内镜下食管黏膜愈合情况优于对照组(均P<0.05),不良反应少。结论治疗组在反流性食管炎中的优势明显,安全性高,有较高的临床价值。     

莫沙必利联合奥美拉唑治疗反流性食管炎的效果评价

目的研究莫沙必利联合奥美拉唑治疗反流性食管炎的效果。方法病例资料来源于我院2014年2月至2015年10月就诊的83例反流性食管炎患者。随机进行分析。83例患者分为A组和A+M组。A组以奥美拉唑20毫克/次,2次/天口服;A+M组以以奥美拉唑20毫克/次,2次/天口服;莫沙必利5毫克/次,3次/天口服。比较(1)反流性食管炎临床治疗效果;(2)内镜下黏膜愈合率、不良反应率;(3)干预前和干预后患者症状积分、生活质量、pH<4反流次数和反流百分比时间的差异。结果 (1)A+M组对比A组反流性食管炎临床治疗效果更高,P<0.05;(2)A+M组对比A组内镜下黏膜愈合率更高,P<0.05;不良反应两组差异不显著,P>0.05;(3)干预前两组症状积分、生活质量、pH<4反流次数和反流百分比时间相似,P>0.05;干预后A+M组对比A组症状积分、生活质量、pH<4反流次数和反流百分比时间改善更显著,P<0.05。结论莫沙必利联合奥美拉唑治疗反流性食管炎效果确切,可有效改善患者临床症状,减少反流次数和时间,促进黏膜愈合,提升患者生存质量,且不良反应少,安全性高,值得推广。     

康复新液联合根治Hp三联疗法等治疗反流性食管炎伴Hp感染疗效分析

目的 比较康复新液联合根治Hp三联疗法(奥美拉唑、阿莫西林、克拉霉素)等治疗反流性食管炎伴幽门螺杆菌感染疗效,探讨理想的治疗方案.方法 收集反流性食管炎伴幽门螺杆菌感染患者162例,根据治疗方案将其分为两组:分别采用康复新液联合枸橼酸莫沙必利、奥美拉唑、阿莫西林、克拉霉素治疗2周后继续服用康复新液、枸橼酸莫沙必利、奥美拉唑6周,以及枸橼酸莫沙必利、根治Hp三联疗法(奥美拉唑、阿莫西林、克拉霉素)治疗2周后,继续服用枸橼酸莫沙必利、奥美拉唑6周治疗,比较两组治疗效果.结果 临床治疗上康复新液联合枸橼酸莫沙必利、奥美拉唑、阿莫西林、克拉霉素治疗与枸橼酸莫沙必利、奥美拉唑、阿莫西林、克拉霉素疗法在反流性食管炎疗效明显优于后者,差异有统计学意义(P<0.05),在幽门螺杆菌感染清除率上虽然无明显差异(P>0.05),但在幽门螺杆菌根除率上前者明显高于后者.结论 康复新液对反流性食管炎食管粘膜损伤有明显修复作用,幽门螺杆菌感染清除上具有明显辅助治疗作用,对治疗反流性食管炎伴感染患者有良好应用前景.     

奥美拉唑与多潘立酮联合应用治疗小儿胃食管反流病疗效观察

目的 评价奥美拉唑和多潘立酮联合应用治疗小儿胃食管反流病的疗效.方法 对182例反流性食管病患儿在应用奥美拉唑和多潘立酮联合治疗前后的临床表现、24h食管pH监测值、电子胃镜检查及内镜下黏膜活检的变化情况及不良反应进行比较.结果 用药前及用药后每2周进行临床症状观察,发现治疗后临床症状逐渐改善及消失,24h食管pH监测各项指标在治疗后均明显小于治疗前(P＜0.01);治疗后电子胃镜检查及活检发现患儿反流性食管炎表现逐渐好转或消失,差异有统计学意义(P＜0.01),两药联用未见明显不良反应.结论 奥美拉唑联合多潘立酮治疗小儿胃食管反流病疗效确切.     

雷贝拉唑联合莫沙必利治疗反流性食管炎的临床疗效观察

目的:分析雷贝拉唑+莫沙必利在反流性食管炎治疗中的效果.方法:选取所在医院2015年1月～2016年8月150例反流性食管炎患者,随机分组,对照组(n=75)采用莫沙必利治疗,观察组(n=75)给予雷贝拉唑+莫沙必利,对比两组反流时间、反流次数、食管黏膜愈合时间、治疗效果以及不良反应.结果:观察组的总有效率高于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率(5.33％)低于对照组(21.33％),差异有统计学意义(P<0.05);观察组反流时间、反流次数、食管黏膜愈合时间均低于对照组,差异有统计学意义(P<0.05).结论:雷贝拉唑+莫沙必利临床效果显著,既能有效减少反流次数,又能有效控制不良反应,并能促进食管黏膜加速愈合,因而值得应用推广.     

奥美拉唑联合西咪替丁治疗反流性食管炎临床分析

目的:探讨反流性食管炎患者应用奥美拉唑+西咪替丁治疗的临床效果。方法:抽取2017年4月-2018年4月我院收治的反流性食管炎患者62例为研究对象,30例行奥美拉唑治疗者作为对照组,32例行奥美拉唑+西咪替丁治疗者作为实验组,观察两组疗效及安全性。结果:(1)实验组治疗总有效率显著高于对照组(P0.05);(2)实验组治疗后食管动力学指标水平显著高于对照组(P0.05);(3)实验组副反应总发生率与对照组无统计学差异(P0.05)。结论:在口服奥美拉唑基础上,予以反流性食管炎患者西咪替丁治疗,可促进食管黏膜结构及动力学恢复,减轻反流症状,且联合方案安全可靠,值得推广。     

Effects of curcumin on reflux esophagitis in rats

The preventive effect of curcumin, a compound isolated from the rhizome of Curcuma longa, on experimental reflux esophagitis in rats was investigated in order to validate its potential therapeutic use for gastroesophageal reflux disease. Curcumin (20 mg/kg, i.d.), the antioxidative agent dimethyl sulfoxide (DMSO) (1 ml/kg, i.p.) or the proton pump inhibitor lansoprazole (1 mg/kg, i.d.) inhibited the formation of acute acid reflux esophagitis by 52.5, 61.5 and 70.9% respectively. Curcumin alone was not effective in preventing chronic acid reflux esophagitis, but the combination of curcumin and DMSO reduced the mortality rate and the severity of the esophagitis ulcer index to the same extent (56.5%) as did the lansoprazole (53.9%). Intraduodenal administration of curcumin also markedly prevented the formation of acute mixed reflux esophagitis, together with reducing the incidence or the severity of neutrophil infiltration, when compared to a control group. In contrast, lansoprazole tended to increase the severity of all histopathological changes, when compared to either the control or the curcumin-treated group. Aminoguanidine, a specific inducible nitric oxide synthase inhibitor, had no preventive effect against both types of acute reflux esophagitis models, and increased the mortality in the chronic acid reflux esophagitis model. From these results, it is indicated that curcumin can effectively prevent acute reflux esophagitis formation. Although curcumin is less potent than lansoprazole in inhibiting acid reflux esophagitis, it is superior to lansoprazole in inhibiting mixed reflux esophagitis. The antiulcerogenic mechanisms are considered to be closely associated with its antioxidant nature and antiinflammatory property.     

反流性食管炎食管外表现36例临床分析

目的:探讨反流性食管炎(RE)食管外表现的诊治方法.方法:采用胃镜、24h食管pH监测,喉镜检查明确诊断,36例患者均给予质子泵抑制剂和胃肠动力药治疗,分析治疗前后症状及检查结果的变化情况.结果:36例患者治疗后有效率为94.44%,无效2例.结论:胃镜、24h食管pH监测、喉镜检查有助于确诊胃食管反流病(GERD),应用质子泵抑制剂和胃肠动力药治疗临床疗效好.     

以咽异感征为主要表现的反流性食管炎的诊治体会

目的探讨咽异感征与反流性食管炎的相关性。方法分析30例以咽异感征为主要表现的反流性食管炎患者的诊疗经过。结果本组病例确诊前曾反复就诊,治疗效果差,经确诊后给予质子泵抑制剂、促胃动力剂、以及甘桔冰梅片治疗后,症状明显缓解及消失。结论咽异感征不是反流性食管炎的主要依据,但却是常见的临床表现,因此对于咽异感征患者应考虑反流性食管炎的可能,并及时行胃镜检查,以明确诊断。     

Gastroesophageal reflux disease (GERD): current agents and future perspective

The objectives of medical treatment of patients with gastroesophageal reflux disease (GERD) are relief of symptoms and healing of esophagitis, which can be achieved, at least in part, by drugs which suppress acid secretion. In patients with GERD symptoms and/or mild esophagitis, the best and most cost-effective therapeutic strategy is to start with a proton pump inhibitor with subsequent trial of step down of the intensity of therapy (e.g. H2-receptor antagonists). In patients with moderate or severe esophagitis, proton pump inhibitors are the mainstay of treatment and the most effective in preventing symptoms and esophagitis. In patients with mild disease, the recurrence of symptoms is less frequent and many patients may not need continuous maintenance therapy or may require treatment with either low dose proton pump inhibitors, H2-receptor antagonists or cisapride only. H. pylori eradication might be needed in GERD patients on long-term treatment with proton pump inhibitors, but the benefit of this strategy has not yet been adequately demonstrated. Antireflux surgery is a maintenance option for the young patient on long-term medical therapy. Improved medical therapy for GERD might depend on future agents with different therapeutic targets, including GABA inhibitors and nitric oxide modulating drugs in the control of the lower sphincter esophagus and in motility disorders, free radical scavengers in the prevention of mucosal damage and COX-2 specific inhibitors in the prevention of the progression of Barret's esophagus to adenocarcinoma. Finally, the modulation of some growth factors might have a potential role in delayed esophageal ulcer healing, refractory esophagitis and in Barrett's esophagus.     

反流性食管炎与气道高反应性研究

目的：探讨反流性食管炎对气道反应性的影响。方法：选择经支气管激发试验确诊为支气管哮喘且伴有烧心、反酸等消化道症状的患者32例，再行电子胃镜检查，比较反流性食管炎严重程度与肺功能各参数的关系。对确诊为反流性食管炎患者中的12例服用洛赛克20mg，每日2攻，2周后再行肺功能检查测定气道反应性，对比治疗前后肺功能各参数的改变。结果：32例哮喘且伴有消化道症状的患者中经胃镜检查反流性食管炎发生率为84％（27／32）．其中12例患者服用洛赛克治疗2周后气道反应性减低，FEV1与FEV1／FVC无明显改变。结论：胃食管反流可诱发并加重哮喘，通过治疗胃食管反流可以控制哮喘。     

雷贝拉唑对不同类型胃食管反流病疗效和食管黏膜环氧化酶2的影响

目的：观察雷贝拉唑对不同类型胃食管反流病(CERD)的疗效和对食管黏膜环氧化酶2(COX-2)的影响。方法：GERD病人89例,其中反流性食管炎(RE)组51例和内镜检查阴性的胃食管反流病(NERD)组38例,2组均予雷贝拉唑10 mg,po,qd,共8 wk。正常对照组30例。症状和胃镜表现采用分级和记分法记录；抑郁和焦虑采用Hamilton抑郁量表和焦虑量表评价；COX-2应用链霉菌抗生物蛋白-过氧化物酶(SP)免疫组化法检测。结果：治疗前RE组和NERD组的症状评分无显著差异(P＞0.05)。治疗后RE组与NERD组的烧心样胸痛和反酸的评分明显减低,并可明显改善黏膜的损害,使内镜表现积分明显减低。RE组治愈率和总有效率明显高于NERD组(P＜0.01,P＜0.05)；有效率与进步率NERD组明显高于RE组(P＜0.01,P＜0.05)。RE组复发率和伴随抑郁或焦虑均明显低于NERD。治疗后,RE组的COX-2的阳性率明显减低(P＜0.01)。结论：雷贝拉唑对RE治疗的总有效率明显高于NERD组,并可明显地下调RE的COX-2的表达。     

Esophagitis in children: an update on current pharmacotherapy

Introduction: A common diagnostic entity in children is Esophagitis with multiple etiologies and complex immuno-pathogenic mechanisms. Our understanding of these mechanisms and of the pharmacotherapy of esophagitis is still evolving.

Areas covered: Areas of focus for this review were chosen based on recent clinical practice and research interest in esophagitis in infants and children. A literature search was conducted with the relevant keywords (‘gastroesophageal reflux disease' in pediatric age group, ‘eosinophilia', ‘esophageal eosinophilia', ‘esophagitis', ‘eosinophilic esophagitis', ‘proton pump inhibitors'). Use, safety and efficacy of proton pump inhibitors in young infants and older children, the concepts of esophageal eosinophilia and overlap of reflux and eosinophilic esophagitis are discussed here.

Expert opinion: Proton pump inhibitors are effective in healing reflux esophagitis in children of all ages but do not improve gastroesophageal reflux related symptoms in infants. An overlap in clinical and histological features of reflux and eosinophilic esophagitis exists, and proton pump inhibitors may exert their action in pathways other than just acid suppression. The role of weakly acidic/alkaline reflux in gastroesophageal reflux symptoms, development of newer reflux modifying medications and tools to assess efficacy of therapeutic intervention in eosinophilic esophagitis are promising areas for further research and developing knowledge.     

不同质子泵抑制剂联合莫沙必利治疗返流性食管炎的效果对比研究

目的 探讨不同质子泵抑制剂联合莫沙必利治疗返流性食管炎的有效性和安全性.方法 选取我院收治的202例返流性食管炎患者,随机均分为奥美拉唑组和雷贝拉唑组,奥美拉唑组给予奥美拉唑联合莫沙必利治疗,雷贝拉唑组给予雷贝拉唑联合莫沙必利治疗.比较两组患者治疗总有效率和不良反应发生率的差异.结果 雷贝拉唑组治疗总有效率为97.0％,显著高于奥美拉唑组的86.1％ （P＜0.05）;两组患者均无严重不良反应发生,不良反应发生率比较差异无统计学意义（P＞0.05）.结论 雷贝拉唑联合莫沙必利治疗返流性食管炎疗效确切,无严重不良反应,值得临床广泛推广使用.     

蒲元和胃胶囊在反流性食管炎治疗中的应用效果

目的探讨蒲元和胃胶囊治疗反流性食管炎的临床疗效。方法选取2012年3月－2014年3月收治的反流性食管炎患者120例,随机分成观察组和对照组两组,每组60例。观察组采用蒲元和胃胶囊进行治疗,对照组采用六味安消胶囊进行治疗,比较两组患者治疗的总有效率。结果两组患者治疗8周后,观察组的临床症状总有效率为98.33%（59/60）,与对照组的86.67%（52/60）相比,差异具有统计学意义（P〈0.05）;观察组患者的胃镜下治疗总有效率为96.67%（58/60）,与对照组的88.33%（53/60）相比,差异具有统计学意义（P〈0.05）。结论蒲元和胃胶囊治疗反流性食管炎能取得较为理想的疗效。     

Persistence and adherence to proton pump inhibitors in daily clinical practice

BACKGROUND: Proton pump inhibitors are widely used, but little is known about the usage pattern in different indications. AIM: To analyse proton pump inhibitor usage patterns in the general population. METHODS: A cohort of 16 311 incident proton pump inhibitor users was identified in the Integrated Primary Care Information database, a Dutch general practice research database. Persistence and adherence were calculated by indication. Risk factors were identified by logistic regression analysis. RESULTS: One-year persistence was 31% in patients using proton pump inhibitors for gastro-oesophageal reflux. Persistence was higher in oesophagitis grade A/B (54%), grade C/D (73%) and Barrett's oesophagus (72%), compared to patients with only reflux symptoms (27%). Approximately 25% of patients with non-reflux dyspepsia or Helicobacter pylori-associated indications used proton pump inhibitors for more than 6 months. Half of all patients used proton pump inhibitors <80% of time indicating intermittent use, which was independent of indication. Exception were patients with Barrett's oesophagus, who were most adherent. CONCLUSIONS: A substantial proportion of patients with indications not requiring long-term treatment use proton pump inhibitors for an extended period. Half of the patients used proton pump inhibitors on-demand or intermittently. Such usage pattern is probably sufficient for most patients, but may be inadequate if proton pump inhibitors are used for serious diseases, such as severe oesophagitis or Barrett's oesophagus.