反流性疾病问卷对胃食管反流病的诊断价值

目的探讨反流性疾病问卷（RDQ）在诊断胃食管反流病中的价值。方法在接待消化内科门诊就诊病人中,对存在反流相关症状者进行问卷调查。记录烧心、反流、非心源性胸痛、反酸4个症状的频率及程度的积分,分析经内镜检查证实的反流性食管炎患者RDQ积分分布情况,计算诊断GERD的临界值。结果1655例门诊病人中379人有反流症状,男女比例1.11：1,平均年龄50.16±14.17岁。经内镜检查,诊断反流性食管炎122例,内镜正常者73例,二者RDQ评分差异有显著。以RDQ分值16为临界值,Youden指数最大,ROC曲线下面积为0.75,对GERD诊断阳性符合率81.48%,阴性符合率为60.92%,敏感度为72.13%,特异度为68.49%。RDQ分值与RE的洛杉矶分级无关。结论RDQ可作为初步诊断胃食管反流病易行有效的方法。     

三种不同检查方法在胃食管反流病诊断中的应用比较

目的:探讨电子胃镜、24 h食管pH值监测及胃食管反流病(GERD)Q评分三种方法在GERD诊断中的临床应用价值。方法:将于2011年4月—2012年6月因烧心、反酸等症状就诊于消化科门诊的120例患者随机分为胃镜组、24 h食管pH值监测组及GERD Q评分组,每组40例,分别接受电子胃镜、24 h食管pH值监测及GERD Q问卷评分,比较分析各种方法对GERD的检出情况。结果:24 h食管pH值监测组40例患者中病理性反流者19例,生理性反流者5例,GERD阳性率显著高于胃镜组及GERD Q评分组,差异具有统计学意义(P<0.05);胃镜组与GERD Q评分组之间差异无统计学意义(P>0.05)。结论:24 h食道pH值监测可以对食管内反流情况进行实时、动态监测,为GERD的临床诊断及不同类型的反流治疗方案提供客观、准确的依据。     

兰索拉唑联合莫沙必利治疗非糜烂性胃食管反流病的疗效观察

目的 观察兰索拉唑治疗非糜烂性胃食管反流病(NERD)的疗效.方法 将64例NERD患者完全随机分为观察组和对照组.观察组32例,予兰索拉唑30 mg,早餐前1次;莫沙比利5 mg,早、中、晚餐前各1次;对照组32例,予兰索拉唑30 mg,早餐前1次.治疗前及治疗8周时进行胃食管反流病量表(GerdQ)评分,并于治疗8周后进行疗效评定.结果 观察组显效20例,有效7例,总有效率为84.4％ (27/32);对照组显效15例,有效5例,总有效率为62.5％ (20/32);2组总有效率比较差异具有统计学意义(P＜0.05).治疗8周后2组GerdQ评分均较治疗前下降[观察组:(7.0±2.0)分比(9.8±2.6)分;对照组:(8.2±2.0)分比(10.3±2.1)分;均P＜0.05],且治疗8周后观察组GerdQ评分低于对照组(P＜0.05).结论 兰索拉唑联合莫沙比利治疗NERD疗效优于单用同剂量兰索拉唑.     

雷贝拉唑治疗胃食管反流病疗效观察

目的：观察雷贝拉唑治疗胃食管反流病的临床疗效。方法：将60例胃食管反流病患者随机分为2组，雷32拉唑组30例，服用雷贝拉唑10mg，qd；对照组服用雷尼替丁150mg，bid，早晚服用。疗程均为4周。结果：雷贝拉唑治疗组临床症状改善明显优于对照组，并明显改善内镜下食管炎分级，且不良反应少。结论：雷贝拉唑治疗胃食管反流病疗效显著。     

埃索美拉唑联合帕罗西汀治疗非糜烂性胃食管反流病的疗效观察

目的探讨埃索美拉唑联合帕罗西汀治疗非糜烂性胃食管反流病的疗效。方法 92例非糜烂性胃食管反流病患者随机分为治疗组和对照组,治疗组46例,予埃索美拉唑20mg,1次/d;帕罗西汀20mg,1次/d;莫沙比利5mg,3次/d;对照组46例,予奥美拉唑20mg,1次/d,莫沙比利5mg,3次/d。疗程为8周。治疗2、4、6、8周时分别作症状评价。结果治疗后两组症状如反酸、烧心、胸痛疗效观察均有明显改善,治疗组疗效高于对照组（P〈0.05）。结论埃索美拉唑联合帕罗西汀治疗非糜烂性胃食管反流病疗效优于同等剂量的奥美拉唑。     

铜陵市城区成人胃食管反流病临床流行病学研究

目的：探讨安徽省铜陵地区胃食管反流病（ GERD）的患病情况。方法采用症状问卷筛查方法,通过对2012年铜陵地区3个市级医院的消化专科门诊及病房就诊的人群进行调查,采用Zung抑郁自评量表（ SDS）、Zung焦虑自评量表（ SAS）、中文版SF-36生活质量量表进行研究,并建立数据库,进行统计学分析。结果男性患者患病率高于女性,差异有统计学意义（P＜0．01）;GERD以40～60岁年龄多发,不同年龄组间差异有统计学意义（P＜0．05）;但不同文化程度之间无统计学差异（P＞0．05）;GERD患者合并焦虑、抑郁情况的比例明显高于健康人群,差异有统计学意义（P＜0．05）,生活质量与健康人群相比明显下降（P＜0．05）。结论安徽省铜陵地区GERD发病率,与国内患病水平接近;患者易合并抑郁、焦虑,生活质量明显下降,重视GERD患者抑郁、焦虑的治疗,具有非常重要的临床实践意义。     

探讨胃食管反流病治疗方法在咽喉反流性疾病治疗中的疗效

目的 探讨胃食管反流病的治疗方法在咽喉反流性疾病治疗中的疗效.方法 98例咽喉反流性疾病(以慢性咽喉炎症状为主要临床表现)患者,分为实验组和对照组,各49例;对照组采用慢性咽喉炎常规治疗方法,实验组采用胃食管反流病治疗方法,疗程均为12周,对比两组治疗后总有效率.结果 实验组的总有效率为87.76％,对照组的总有效率为26.53％,实验组治疗后总有效率明显高于对照组,差异有统计学意义(P＜0.05);两组患者在治疗过程中均未见明显不良反应发生.结论 胃食管反流病治疗方法在治疗咽喉反流性疾病中疗效显著,可明显改善患者临床症状,值得临床推广.     

Evolving pharmacological approaches in gastroesophageal reflux disease

Introduction: Proton pump inhibitors (PPIs) have considerably improved quality of life in patients with gastroesophageal reflux disease (GERD). However, many patients remain symptomatic despite standard PPI therapy.

Areas covered: This review focuses on evolving therapeutic strategies related to the pathophysiological processes of GERD and insufficient response to PPIs. Several clinical trials evaluated new PPI formulations and newer types of acid-suppressive drugs. These studies have evaluated traditional end points in GERD, but have not shown clinical superiority to current PPIs. Novel therapeutic strategies targeting underlying mechanisms of GERD, such as transient lower esophageal sphincter relaxations (TLESRs) and esophageal hypersensitivity, are being developed for add-on therapy to PPIs. Prokinetic drugs may also have some potential in the add-on treatment of GERD with insufficient response to PPIs. Add-on studies are hampered by insufficient information on optimal patient selection and lack of established end points.

Expert opinion: Newer drugs for symptomatic control in GERD have largely focused on improved acid suppression, without evidence of clinical superiority. Drugs targeting esophageal motility and sensitivity to be used as add-onc therapy in PPI insufficient responders have not reached Phase III trials to date, due to difficulties with patient selection, tolerability and end points.     

胃食管反流病的药物治疗

在简要介绍胃食管反流病发病机理的基础上,对其药物治疗的临床实施和疗效评价进行阐述,为胃食管反流病的临床治疗提供参考。     

幽门螺杆菌感染与胃食管反流的关系

目的探讨胃食管反流病(GRED)与幽门螺杆菌(Hp)的关系。方法确诊的胃食管反流病患者60例及浅表糜烂性胃炎患者63例(对照组),均行幽门螺杆菌检测,再将60例GERD患者分为2组,25例常规三联抗HP治疗,为HP根除组,另外35例作为Hp持续感染组。随访1年。结果 60例GERD患者Hp感染率为58.3%,对照组Hp感染率82.5%,GERD患者Hp感染率低于对照组,差异有统计学意义(P0.05)。Hp根除组GERD复发率高于Hp持续感染组,差异有统计学意义(P0.05)。对照组Hp根除后GERD的发病率为25.5%。结论 Hp感染可能在GERD的发病过程中起保护作用。     

妊娠期胃食管反流病的治疗

妊娠期胃食管反流病(GERD)的治疗是颇具挑战性的，最为强调的是生活方式和饮食调节；一线治疗药物是非系统性吸收的抗酸剂、粘膜保护剂；H2受体阻滞剂应用历史较长、临床监测资料多，目前还是治疗中、重度妊娠期GERD的相对安全药物(尼扎替丁除外)；质子泵抑制剂对胎儿的不良反应尚需进一步观察，建议在有顽固性GERD症状、其他药物疗效不显时应用，且尽量避免在妊娠早期应用。倾向于不用促动力剂。对妊娠期GERD的治疗，最为安全、有效的方案是用尽可能少的全身性作用药物来缓解或消除症状，以提高生活质量。     

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.     

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。     

舒肝益胃颗粒治疗胃食管反流病的临床研究

目的:观察舒肝益胃颗粒治疗胃食管反流病的临床疗效。方法:将80例胃食管反流病肝胃郁热型患者随机分为两组,治疗组服用舒肝益胃颗粒,对照组服用枸橼酸莫沙必利片。4周为1个疗程。结果:治疗组总有效率为92.5%,对照组80.0%,两组治疗后中医症候疗效比较差异有统计学意义(P<0.05);治疗组和对照组患者胃镜下炎症积分比较,总有效率分别为92.5%和67.5%,两组比较差异有统计学意义(P<0.05);治疗组停药复发率明显低于对照组。结论:舒肝益胃颗粒治疗胃食管反流病具有良好的临床疗效。     

乌灵胶囊治疗伴有焦虑状态的胃食管反流病的疗效

目的：探讨乌灵胶囊治疗伴焦虑状态的胃食管反流病（GERD）患者的临床疗效。方法：选择Zung焦虑自评量表（SAS）评分≥50分的64例GERD患者,随机分为2组,治疗组32例给予乌灵胶囊和埃索美拉唑镁肠溶片,对照组32例给予埃索关拉唑镁肠溶片;疗程8周。应用胃食管反流病症状分级及sAS的评分变化进行疗效评定。结果：治疗8周末,治疗组中显效率、总有效率分别为58．9％和93．1％,对照组分别为32．2％和67．9％,有统计学差异。两组内治疗前与治疗后SAS评分均有统计学差异;治疗后第4、8周末治疗组SAS评分与对照组相比有统计学差异。结论：乌灵胶囊联用埃索美拉唑镁肠溶片能安全有效治疗伴有焦虑状态的GERD患者。     

乌灵胶囊治疗伴有焦虑状态的胃食管反流病的疗效

目的：探讨乌灵胶囊治疗伴焦虑状态的胃食管反流病（GERD）患者的临床疗效。方法：选择Zung焦虑自评量表（SAS）评分≥50分的64例GERD患者,随机分为2组,治疗组32例给予乌灵胶囊和埃索美拉唑镁肠溶片,对照组32例给予埃索关拉唑镁肠溶片;疗程8周。应用胃食管反流病症状分级及SAS的评分变化进行疗效评定。结果：治疗8周末,治疗组中显效率、总有效率分别为58．9％和93．1％,对照组分别为32．2％和67．9％,有统计学差异。两组内治疗前与治疗后SAS评分均有统计学差异;治疗后第4、8周末治疗组SAS评分与对照组相比有统计学差异。结论：乌灵胶囊联用埃索美拉唑镁肠溶片能安全有效治疗伴有焦虑状态的GERD患者。     

Vonoprazan for treatment of gastroesophageal reflux: pharmacodynamic and pharmacokinetic considerations

Introduction: About 30–40% of GERD patients report an inadequate response to proton pump inhibitors (PPIs) due to their suboptimal pharmacological profiles. Recently, a new synthesized P-CABs, vonoprazan, showed higher suppression of gastric acid secretion as compared to lansoprazole.

Areas covered: This review provides an update on the pharmacokinetic properties of vonoprazan and their correlates with pharmacodynamics; preliminary data on the therapeutic efficacy of vonoprazan as compared to lansoprazole in GERD patients

Expert opinion: At variance from all available PPIs, vonoprazan acts directly on H+,K+-ATPase irrespectively of its activity, providing a fast onset of action without requiring acid activation and specific administration timing. Clinical and pharmacological investigations have confirmed a more rapid, potent and prolonged inhibition of acid secretion, including a better nighttime acid control, and a less antisecretory variability, as compared with PPIs. Preliminary data in patients with erosive esophagitis (EE) have shown the non-inferiority of vonoprazan to lansoprazole in terms of symptom relief and healing rate. Since these pharmacokinetic advantages, it is expected that it will have a significant favorable impact on GERD management. However, the clinical use of vonoprazan raises also some issues about its efficacy and safety in the long-term that deserve verification and careful investigation.     

胃食管反流病相关因素探讨

目的 探讨胃食管反流病(GERD)的相关危险因素.方法 选择消化内科就诊的患者1 200例,其中GERD患者99例为观察组,另选择99例非GERD患者为对照组,通过问卷调查及食管、胃内压测定等方法分析GERD患者各相关危险因素.比较观察组和对照组食管下括约肌的平均压力(LESP)、食管下括约肌长度(LESL)、胃内压(GP)、屏障压(LESP-GP)及LESP/GP等指标.结果 1200例参加问卷调查的患者中,共确诊GERD患者99例,比例为8.25％.多因素Logistic回归分析显示常进食过饱、睡前进食、喜油腻食物、喜辛辣食物、大量饮酒及吸烟是影响GERD发病的重要因素.观察组LESL、LESP/GP及LESP-GP均显著小于或低于对照组,GP显著高于对照组,差异均有统计学意义(t=12.216、12.515、8.973、3.437,均P＜0.05).结论 多项不良的饮食习惯及生活方式是GERD的重要危险因素,食管下括约肌功能异常及胃内压力增大在GERD发病中占有重要的地位,应该有针对性地采取积极的干预措施.     

Pharmacoeconomic issues of the treatment of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is one of the most common diagnoses in a gastroenterologist’s practice. Gastroesophageal reflux (GER) describes the retrograde movement of gastric contents through the lower oesophageal sphincter (LES) to the oesophagus. GER can occur physiologically and may be accompanied by symptoms. The introduction of endoscopes and ambulatory devices for continuous monitoring of oesophageal pH (24 h pH monitoring) has led to great improvement in the ability to diagnose reflux disease and reflux-associated complications. The development of pathological reflux and GERD can be attributed to many factors. Pathophysiology of GERD includes transient lower oesophageal sphincter relaxations (TLESRs), incompetent LES because of a decreased lower oesophageal sphincter pressure (LESP) and deficient or delayed oesophageal acid clearance. Uncomplicated GERD may be treated by modification of lifestyle and eating habits in an early stage of GERD. The various agents currently used for treatment of GERD include mucoprotective substances, antacids, H₂-blockers, prokinetics and proton pump inhibitors (PPIs). Although these drugs are effective, they do not necessarily influence the underlying causes of the disease by improving the oesophageal clearance, increasing the LESP or reducing the frequency of TLESRs. The following article gives an overview regarding current concepts of the pathophysiology and pharmacological treatment of GERD stressing on pharmacoeconomic issues of the treatment and discusses the advantages and disadvantages for step-up and step-down therapy.     

右旋兰索拉唑的药理学特点及在胃食管反流病治疗中的应用

虽然质子泵抑制剂(PPI)在胃食管反流病(GERD)治疗方面取得了很大的成功,但是抑酸时间不足、患者依从性差等挑战仍然存在。近期,美国FDA批准了一种新的PPI药物右旋兰索拉唑(dexlanso-prazole,日本武田公司开发,商品名:DexliantTM),目前主要用于糜烂性食管炎急性期及维持期的治疗,以及非糜烂性胃食管反流疾病烧心症状的控制。该药物采用独特的双层缓释技术,可以维持更长的作用时间,达到更好的抑酸效果,且安全性和耐受性良好。