质子泵抑制剂治疗胃食管反流性咽喉炎的Meta分析

目的探讨质子泵抑制剂对胃食管反流性咽喉炎的治疗作用及其安全性,为胃食管反流性咽喉炎的临床治疗提供指导依据。方法计算机检索PubMed、CENTRAL、EMbase、the ISI Web of Knowledge databases、VIP、CNKI、CBM和WANFANG数据库,查找所有探讨质子泵抑制剂对胃食管反流性咽喉炎治疗作用的随机对照试验,检索时限均为建库至2012年3月2日。同时手检纳入文献的参考文献。按纳入排除标准由3名研究者独立进行RCT的筛选、资料提取和质量评价后,采用RevMan 5.1软件进行Meta分析,并采用GRADE系统进行证据质量评价。结果共纳入8个研究,591例患者。Meta分析结果显示:质子泵抑制剂治疗胃食管反流性咽喉炎的总体有效率[OR=7.79,95%CI(2.20,27.51),P<0.05]高于对照组,咳嗽症状缓解效率[OR=2.29,95%CI(0.83,6.35),P>0.05],与对照组比较差异不显著,内镜检查好转率[OR=18.83,95%CI(1.86,190.60),P<0.05],高于对照组。结论质子泵抑制剂对胃食管反流性咽喉炎的治疗作用较对照组明显;但因纳入研究较少、质量参差不齐、样本含量小、各研究方法变异性大,建议临床上审慎选择使用;需要更多高质量、大样本、多中心的随机对照试验进一步论证。     

反流性咽喉炎的研究进展

随着对胃食管反流病认识的深入,其对咽喉部的影响越来越受到临床的关注,研究证明它是导致咽喉部疾病的重要致病因素之一。胃食管反流对消化系统影响的研究很多,但其与咽喉反流性疾病的相关研究甚少,很多基层医生对该病还不甚了解。本文主要对反流性咽喉炎的发病机制、临床表现、诊断方法和治疗作一综述。     

铝碳酸镁联合质子泵抑制剂治疗胃食管反流性咽喉炎疗效观察

背景:与胃食管反流相关的慢性咽喉炎称为胃食管反流性咽喉炎(GERL)。GERL常规治疗效果欠佳,临床上常表现为难治性咽喉炎。目的:观察铝碳酸镁联合质子泵抑制剂(PPI)治疗GERL的疗效和安全性。方法:600例根据临床症状、咽喉部体征和24 h双通道食管pH监测结果诊断的GERL患者纳入研究。患者随机分为治疗组和对照组,每组300例。两组患者均接受常规治疗,治疗组在常规治疗的基础上加用铝碳酸镁片1.0 g tid和雷贝拉唑钠肠溶片20 mg bid,疗程4～6周。比较两组患者的24 h食管pH监测结果和临床症状评分,根据临床症状和体征改善情况进行疗效评价。结果:治疗组与对照组基线情况差异无统计学意义。治疗后,治疗组食管近、远端pH<4时间百分比和DeMeester计分较治疗前明显降低,且明显低于对照组治疗后,差异均有统计学意义(P<0.01);治疗组临床症状评分改善情况和总有效率(96.7%对66.3%)亦显著优于对照组(P<0.01)。两组治疗过程中均未出现严重不良反应。结论:在常规治疗咽喉炎的基础上联合应用铝碳酸镁和PPI对GERL疗效显著且安全,值得在临床上推广应用。     

老年反流性咽喉炎的诊断与治疗

<正>反流性咽喉炎(laryngopharyngeal reflux,LPR)指因胃内容物反流至食管上括约肌(UES)以上部位所引起一系列症状和体征的总称,主要表现为慢性咳嗽、多痰、声嘶、异物感、哮喘等症状,可占耳鼻咽喉科门诊患者总数的10%[1]。虽然LPR经常与胃食管反流病(gastroesophageal reflux disease,GERD)并存,并且发生率亦随胃食管反流程度加重而增加[2],但目前仍然倾向认为两者是相互关联而又不同的两种疾病[3]。     

反流性食管炎食管外表现与酸反流关系的研究

目的探讨反流性食管炎食管外表现与酸反流的关系。方法研究对象为2006年1月至2007年2月在卫生部北京医院消化科、呼吸科及耳鼻喉科门诊和住院的患者,均经胃镜检查证实为反流性食管炎(RE),具有烧心、反酸等胃食管反流和(或)RE的食管外症状(咳嗽、咽喉痛、咽部异物感、声音嘶哑等)。依据患者的主要症状分为食管外表现组及对照组(不具有食管外表现)。食管外表现组32例,对照组35例。所有患者在治疗前均进行24 h食管pH监测,并于治疗前、后对症状积分评定。所有患者均给予质子泵抑制剂(PPI)治疗。结果食管外表现组与对照组PPI治疗的有效率分别为86.4%与91.7%,差异无统计学意义(P>0.05)。结论反流性食管炎的食管外症状与酸反流显著相关。     

反流性食管炎诊断及治疗指南(2003年)

中华医学会消化内镜分会于2003年10月19日～22日在济南召开了全国食管疾病诊断治疗研讨会，会议对学会1999年8月烟台制定的反流性食管病(炎)诊断及治疗方案(试行)进行了总结回顾，并对其内容提出了具体修改意见，2004年2月7日学会又进行了讨论、统一，综合整理如下。     

质子泵抑制剂治疗急性反流性食管炎的系统回顾

成年人胃食管反流病发病率约为 10 %左右 ,常表现为烧心感。质子泵抑制剂 (ＰＰＩ)可有效治愈反流性食管炎 ,且无论在治愈糜烂或缓解相关症状方面都明显优于Ｈ2 受体拮抗剂。抑酸强度与食管炎治愈率有明显相关性。目前在英国获准上市的治疗反流性食管炎的ＰＰＩ包括 :奥美拉唑(ＯＭＥ ,2 0ｍｇ)、兰索拉唑 (ＬＡＮ ,30ｍｇ)、潘妥拉唑 (ＰＡＮ ,4 0ｍｇ)、雷贝拉唑 (ＲＡＢ ,2 0ｍｇ)以及新制剂埃索美拉唑 (ＥＳＯ ,4 0ｍｇ)。ＥＳＯ是ＯＭＥ的Ｓ异构体 ,药代动力和药效学表明其肝脏首过效应小于ＯＭＥ ,血浆清除率亦低。ＥＳＯ 4 0ｍｇ的药…     

质子泵抑制剂(奥美拉唑)试验在胃食管反流病中的诊断价值

目的　探讨质子泵抑制剂奥美拉唑 (商品名 :洛赛克 )试验对胃食管反流病 (GERD)的诊断价值。方法　根据临床反流症状、食管 2 4hpH监测、胃镜检查结果 ,将 15 2例有反流症状的GERD(12 3例 )与非GERD病人 (2 9例 )随机、双盲分成奥美拉唑 2 0mg/d(A组 ,5 0例 )、40mg/d(B组 ,5 1例 )及对照组 (C组 ,5 1例 ,第一周用安慰剂 ,第二周改用奥美拉唑 40mg/d) ,服药时间为 1周和 2周 ,记录服药前后病人烧心、反酸、反食、胸骨后疼痛症状积分的改变 ,按症状积分下降值判定诊断 ,与食管 2 4hpH监测、胃镜检查结果进行对比分析。结果　A、B、C三组的GERD病人 ,服药 1周后反流症状积分下降分别为 :5 .0± 4.8、4.9± 4.6、2 .3± 4.0 ,下降率分别为 35 .5 %、34 .9%、15 .3%。以症状积分下降 2分为标准 ,奥美拉唑试验诊断GERD的价值最佳。不同服药剂量分析 ,2 0mg/d服 1周组 ,试验敏感性、特异性分别为 82 .5 %、40 .0 %,符合率 76 .7%;40mg/d组则分别为88.1%、44 .4%和 81.0 %。两者比较差异无显著性。对服药时间分析 ,则以服奥美拉唑 2 0mg/d 1周为佳。结论　奥美拉唑试验是GERD临床诊断的一种可靠方法。     

雷贝拉唑联合莫沙必利治疗食管反流性咽喉炎56例临床分析

胃食管反流性疾病（gastroesophageal reflux dis-ease,GERD）是指胃十二指肠内容物反流入食管引起烧心等症状的疾病,可引起反流性食管炎（refluxesophagitis,RE）,以及咽喉、气道等食管邻近的组织损害[1]。Halstead[2]发现,GERD可引起食管反流性咽喉炎,引起顽固性咳嗽、咽喉不适、声嘶等症状,质子泵抑制剂及胃肠动力药能够显著改善症状。我们于     

两种用药方案治疗食管反流性咽喉炎的疗效比较

目的:探讨临床上应用莫沙必利与雷贝拉唑联合治疗食管反流性咽喉炎患者的效果.方法:选择在2011-07/2014-07湖北医药学院附属人民医院收治的130例食管反流性咽喉炎患者,将患者随机分为给予莫沙必利联合雷尼替丁治疗的对照组,和给予莫沙必利与雷贝拉唑联合治疗的治疗组,每组65例,然后将对照组患者与治疗组患者的治疗总有效率、食管的p H值<4时间百分比和临床症状总分等指标进行比较.结果:在治疗组患者中,治疗的总有效率为95.38%,给予常规治疗的对照组患者中,治疗的总有效率为67.69%.治疗组优于对照组,组间差异有统计学意义(P<0.05);在治疗后,两组患者的第一通道p H<4时间百分比、第二通道p H<4时间百分比以及临床症状总分均较治疗前有改善,同时,治疗组改善效果明显优于对照组,差异均有统计学意义(P<0.05);两组患者在不良反应发生率上差异无统计学意义(P>0.05).结论:应用莫沙必利与雷贝拉唑联合治疗食管反流性咽喉炎,具有显著的治疗效果、减轻临床症状并且安全性高,有着重要的临床参考意义.     

埃索美拉唑治疗反流性食管炎四周和八周的疗效评价

目的对埃索美拉唑治疗反流性食管炎的疗效进行系统回顾,并用Meta分析比较埃索美拉唑与其他质子泵抑制剂(PPIs)的治疗效果。方法对2000年1月~2005年12月中国生物医学文摘数据库(CBMdisk)、MEDLINE和Cochrane图书馆的文献进行光盘检索,对入选的埃索美拉唑治疗反流性食管炎疗效的RCT试验进行系统回顾,对各研究结果按照不同的质子泵抑制剂分组进行同质性或异质性检验合并数据。结果埃索美拉唑40mg对反流性食管炎4周和8周的治愈率、治疗4周后烧心症状的缓解率均优于奥美拉唑20mg、兰索拉唑30mg和泮妥拉唑40mg。结论埃索美拉唑40mg对反流性食管炎的治愈率和烧心症状的缓解率略优于奥美拉唑20mg、兰索拉唑30mg和泮妥拉唑40mg。     

难治性胃食管反流病诊断方法的研究进展

众多学者把质子泵抑制剂(proton pump inhibitors,PPIs)治疗不应答的胃食管反流病(gastroesophageal reflux disease,GERD)称为难治性胃食管反流病,本病是当前消化系统疾病谱中最为顽固的治疗难题之一.近年来众多研究者运用多种诊察手段来研究本病,希望找到该病的发病机制.本文就最近国内外有关难治性GERD的诊断方案,发病机制及相关研究结果等内容作一综述.     

泮托拉唑治疗老年人反流性食管炎的长期疗效观察

目的探讨泮托拉唑治疗老年人反流性食管炎及预防复发的临床疗效。方法 70例反流性食管炎老年患者随机分为两组,每组35例,A组服用泮托拉唑40 mg,2次/d,B组服用泮托拉唑40 mg,1次/d。8周后,治疗有效的患者共61例,其中26例继续口服泮托拉唑40 mg,1次/d,维持治疗48周,另外35例未继续服用泮托拉唑但同时给予随访,并在8周、24周及48周时分别评价临床症状并复查胃镜。结果治疗8周后A组、B组的症状缓解有效率分别为91.4%、82.9%,内镜下食管炎改善有效率分别为97.1%、91.4%。维持治疗患者,24周后临床症状和内镜下食管炎缓解的有效率均为84.6%;48周后临床症状缓解的有效率为88.5%,内镜下食管炎改善有效率为84.6%。未维持治疗组24周及48周时临床症状缓解的有效率分别为48.6%、37.1%。结论泮托拉唑能有效地治疗老年人反流性食管炎及减少复发,维持48周的用药安全、有效。     

长期质子泵抑制剂治疗老年反流性食管炎11例

目的:研究老年反流性食管炎患者长期服用质子泵抑制剂的临床特点和不利因素,为防治老年反流性食管炎提供依据．方法:对11例长期服用质子泵抑制剂的老年人进行随访观察,分析其临床症状及内镜上消化道黏膜病变的发展变化,研究长期用药的影响．结果:11例患者在随访中,长期使用质子泵抑制剂均取得良好的症状控制,1例长期服用后出现十二指肠息肉,病理为绒毛状腺瘤．结论:老年反流性食管炎患者长期服用质子泵抑制剂的的疗效值得肯定,但需警惕对上消化道肿瘤发生的影响．     

Addition of prokinetics to PPI therapy in gastroesophageal reflux disease: A meta-analysis

AIM: To investigate the efficacy of adding prokinetics to proton pump inhibitors (PPIs) for the treatment of gastroesophageal reflux disease (GERD).METHODS: PubMed, Cochrane Library, and Web of Knowledge databases (prior to October 2013) were systematically searched for randomized controlled trials (RCTs) that compared therapeutic efficacy of PPI alone (single therapy) or PPI plus prokinetics (combined therapy) for GERD. The primary outcome of those selected trials was complete or partial relief of non-erosive reflux disease symptoms or mucosal healing in erosive reflux esophagitis. Using the test of heterogeneity, we established a fixed or random effects model where the risk ratio was the primary readout for measuring efficacy.RESULTS: Twelve RCTs including 2403 patients in total were enrolled in this study. Combined therapy was not associated with significant relief of symptoms or alterations in endoscopic response relative to single therapy (95%CI: 1.0-1.2, P = 0.05; 95%CI: 0.66-2.61, P = 0.44). However, combined therapy was associated with a greater symptom score change (95%CI: 2.14-3.02, P < 0.00001). Although there was a reduction in the number of reflux episodes in GERD [95%CI: -5.96-(-1.78), P = 0.0003] with the combined therapy, there was no significant effect on acid exposure time (95%CI: -0.37-0.60, P = 0.65). The proportion of patients with adverse effects undergoing combined therapy was significantly higher than for PPI therapy alone (95%CI: 1.06-1.36, P = 0.005) when the difference between 5-HT receptor agonist and PPI combined therapy and single therapy (95%CI: 0.84-1.39, P = 0.53) was excluded.CONCLUSION: Combined therapy may partially improve patient quality of life, but has no significant effect on symptom or endoscopic response of GERD.     

胃食管反流病埃索美拉唑治疗长期随访研究

目的 研究埃索美拉唑长期维持或间歇治疗胃食管反流病(GERD)的疗效及安全性.方法 28例GERD患者先以每日2次每次20 mg埃索美拉唑为基础进行综合治疗2周,之后按治疗方式分为长期维持治疗组和间歇治疗组.维持治疗组患者为服用缓解症状所需最小剂量半年以上者.间歇治疗组患者每日1次口服埃索美拉唑20 mg维持至症状完全消失后停药,若症状复发则再以相同方案进行治疗.统计分析两组患者的用药剂量、复发情况及长期服用埃索美拉唑的不良反应.结果 13例患者需长期维持治疗(维持时间7～44个月),15例患者可通过间歇治疗达到症状缓解,均未见与埃索美拉唑相关的不良反应.13例长期维持治疗者中,缓解症状所需埃索美拉唑剂量7例为每日1次每次20 mg,5例为每日2次每次20 mg,1例为隔日1次每次20 mg.随访间歇治疗组患者10～57个月,发现服药时间越长,患者缓解时间越长,Pearson相关系数为0.447,差异有统计学意义(P=0.008).结论 GERD患者可通过埃索美拉唑长期维持治疗和间歇治疗两种方式缓解症状,且安全性较好.     

Beneficial effect of probiotics supplements in reflux esophagitis treated with esomeprazole: A randomized controlled trial

BACKGROUND Reflux esophagitis(RE) is a common digestive disorder, and its frequent recurrences cause significant physical pain and are financially burdensome to patients. However, studies on the natural history of treated RE are few. Although proton pump inhibitors(PPIs) as the first-line treatment provide notable symptomatic relief, disordered gut microbiota has been observed among PPI users. Probiotics are commonly administered to patients to regulate the disordered intestinal flora.AIM To evaluate the therapeutic effects in RE patients treated with a combination of esomeprazole and probiotics [Bacillus subtilis(B. subtilis) and Enterococcus faecium(E. faecium)].METHODS One hundred and thirty-four RE patients were randomized into two groups of 67 subjects each. The probiotics group was administered with esomeprazole 20 mg b.i.d. and live combined B. subtilis and E. faecium enteric-coated capsules 500 mg t.i.d. for eight weeks; the placebo group was administered with esomeprazole 20 mg b.i.d. and placebo for eight weeks. Subsequently, 12-wk follow-up was carried out on patients who achieved both endoscopic and clinical cure. Endoscopy,reflux diagnostic questionnaire(RDQ), gastrointestinal symptom rating scale(GSRS), and lactulose hydrogen breath test were performed to evaluate the therapeutic effects. A difference of P < 0.05 was considered statistically significant.RESULTSSixty-six patients in the probiotics group and 64 patients in the placebo group completed the 8-wk treatment. The healing rate and RDQ score had no significant difference between the two groups(P > 0.05). However, the GSRS diarrhea syndrome score was decreased significantly in the probiotics group(P = 0.002),and the small intestinal bacterial overgrowth negative rate in the probiotics group was significantly higher than that in the placebo group(P = 0.002). Of 114 endoscopically and clinically cured patients, 96 completed the follow-up. The logrank test showed that the time to relapse was shorter in the placebo group than in the probiotics group(P = 0.041). Furthermore, the therapy had a significant influence on relapse time, and the risk of relapse in the probiotics group was lower than that in the placebo group at any time point during the 12-wk followup(hazard ratio = 0.52, P = 0.033).CONCLUSION Esomeprazole combined with probiotics(B. subtilis and E. faecium) have a beneficial effect on RE treatment and patient management.     

Rabeprazole is effective for bile reflux oesophagitis after total gastrectomy in a rat model

AIM:To elucidate the effect of a proton pump inhibitor(PPI,rabeparazole)on oesophageal bile reflux in oesophagitis after total gastrectomy.METHODS:Twenty-one 8-week-old male Wistar rats were studied.They were performed oesophagoduodenostomy of total gastrectomy to induce oesophageal reflux of biliary and pancreatic juice.Five rats were performed the sham operation(Sham).On post-operative day 7,they were treated with saline(Control)(n=8)or PPI(rabeprazole,30 mg/kg per day,ip)(n=8)for 2 wk.On post-operative 21,all rats were sacrificed and each oesophagus was evaluated histologically.Oesophageal injury was evaluated by macroscopic and microscopic findings as well as the expression of cyclooxygenase-2(COX2).We measured bile acid in the oesophageal lumen and the common bile duct.RESULTS:At 3 wk after surgery,a histological study analysis revealed an increase in the thickness of the epithelium,elongation of the lamina propria and basal cell hyperplasia in the oesophageal mucosa.The macroscopic ulcer score and microscopic ulcer length of the control group were significantly higher compared to those of the rabeprazole-treated group.The expression of COX2 was significantly increased according to the immunostaining in the control group compared to rabeprazole-treated group.Although there was no difference between the control and PPI groups in the total bile acid in the common bile duct,the bileacid activity in the oesophageal lumen was significantly decreased in the rabeprazole-treated group due to augmentation of the duodenal motor complex.CONCLUSION:With this model,rabeprazole is good effect for reflux esophagitis after total gastrectomy from bile reflux.Bile acid is an important factor in the mucosal lesion induced by duodenal reflux.