24小时pH监测比较西沙必利与雷尼替丁的抗胃食管反流效果

用２４小时ｐＨ动态监测分别观察西沙必利（普瑞博思）和雷尼替丁治疗２１例反流性食管病的抗反流效果，观察两种药物对胃内ｐＨ的影响与抗胃食管反流（ＧＥＲ）作用的相关性。结果表明，西沙必利组和雷尼替丁组治疗后食管酸反流指数均较服药前下降，两组间下降指数比较无显著性差异（Ｐ〉０．０５）。西沙必利组对胃内ｐＨ无影响，雷尼替丁组可降低胃内ｐＨ〈１，ｐＨ〈２和ｐＨ〈３的总时间（％），平均ｐＨ和中位ｐＨ升高，两组比     

食管测压及24小时pH监测结果分析——附60例报告

目的：通过食管测压及ｐＨ监测，观察食管在静息和吞咽后各部分的压力变化，探讨食管测压及ｐＨ监测之临床意义。方法：应用多导胃肠功能测定仪及便携式ｐＨ监测记录仪，对６０例患者进行了食管压力测定及４５例食管动态２４小时ｐＨ监测。结果：２５例患者上、下食管括约肌位置、松驰率、食管蠕动收缩的波幅、时限等，数据与国内报道正常值接近，下食管括约肌静息压（ＬＥＳＰ）及上食管括约肌静息压（ＵＥＳＰ）接近或略低于国内报道正常值。２３例２４ｈｐＨ监测提示有酸反流之患者中，１６例ＬＥＳＰ明显低于正常。结论：有助于贲门失驰缓之早期诊断；ＬＥＳＰ与反流有明显关系。     

胃食管反流病与幽门螺杆菌感染的相关性分析

目的探讨胃食管反流病与幽门螺杆菌感染的相关性。方法选取2014年5月~2015年5月我院治疗的胃食管反流病患者105例,所有患者随机分为观察组53例与对照组52例,观察两组患者发生夜间酸突破的发生率,胃内p H值及两组患者Gerd Q问卷症状评分情况。结果观察组患者的夜间酸突破发生率为28.30,明显低于对照组的51.92%,两组比较差异有统计学意义(P0.05)。两组患者的胃内p H及平均中位p H,夜间胃内p H、夜间平均中位p H比较,差异无统计学意义(P0.05)。观察组患者的上腹痛及恶心症状积分少于对照组,两组比较差异有统计学意义(P0.05)。两组患者的烧心、反流、睡眠障碍、服用腰腹之分及总分比较,差异无统计学意义(P0.05)。结论幽门螺杆菌与胃食管反流病夜间酸突破两者之间有一定的相关性,Hp感染对GE R D的发病可能起保护作用。     

不同类型胃食管反流病24h食管pH监测的临床研究

目的：研究不同类型胃食管反流病24h食管pH监测指标之间的相关性。方法对符合胃食管反流病（GERD）诊断标准的43例患者,经内镜检查分为反流性食管炎（RE）组、非糜烂性反流病（NERD）组、Barrettt食管组,随后进行高分辨多通道毛细灌注测压检查及食管pH动态监测,比较各组24h食管pH监测指标。结果三组患者食管pH〈4反流次数（次）,反流持续时间≥5 min反流次数（次）、pH〈4总时间, pH〈4百分时间（%）, DeMeester积分差异无统计学意义（P〉0.05）。结论不同类型胃食管反流病食管粘膜损伤与食管酸反流无相关性,食管组织化生与食管酸反流无相关性。     

7例胃食管反流患者的食管测压及24小时pH监测

我科自１９９６年６月～１９９７年７月对４７例有胃食管反流（ＧＥＲ）症状的患者做食管运动功能检测及２４小时ｐＨ监测，并与２０名无胃食管返流者进行对照，现报告如下。材料和方法４７例患者系住院及门诊患者，年龄２４～７０岁，男２６，女２１，男女之比为１２∶...     

幽门螺杆菌感染与胃食管反流病夜间酸突破的相关性探讨

目的 探讨幽门螺杆菌感染和胃食管反流病夜间酸突破的相关性。方法 选取邯郸市第一医院2012年6月-2013年6月收治的胃食管法流病患者100例作为研究对象,随机分为对照组和实验组,每组各有患者50例。对照组患者使用奥美拉唑治疗,实验组患者在对照组的基础上加服枸橼酸铋钾口服液,口服阿莫西林和甲硝唑,两组患者治疗疗程均为10天。检查患者22点～次日凌晨8点期间夜间酸突破情况,并对患者进行RDQ评分。结果 对照组患者夜间酸突破的发生率为22．0％,显著低于实验组的52．0％,差异有统计学意义（P〈0．05）;对照组和实验组患者经治疗ROD评分均显著下降,与治疗前相比差异有统计学意义（P〈0．05）;治疗前后两组患者组间比较差异无统计学意义（P〉0．05）。结论 胃食管反流病症状的发生不依赖夜间酸突破,幽门螺杆菌是胃食管反流病的保护因素,清除幽门螺杆菌会加重夜间酸突破的发生。     

胃食管反流患者应用富马酸伏诺拉生片与雷贝拉唑肠溶胶囊的疗效及药物经济学评价

目的 探讨富马酸伏诺拉生片与雷贝拉唑肠溶胶囊治疗胃食管反流的效果及药物经济学情况。方法 选取2018年2月至2021年10月进行胃食管反流症治疗的2 000例患者,等分法将患者分为对照组和研究组,每组1 000例。对照组采用雷贝拉唑肠溶胶囊治疗,研究组采用富马酸伏诺拉生片治疗。比较2组患者胃食管反流治疗效果、基础酸排出量及不良反应发生率,2组成本-效果比等指标。结果 研究组患者治疗有效率显著高于对照组(P<0.05);研究组基础酸排出量显著小于对照组(P<0.05);研究组临床症状包括反流、腹痛、反酸、嗳气消失时间较对照组短(P<0.05),研究组不良反应发生率显著小于对照组(P<0.05);雷贝拉唑肠溶胶囊的经济性高于富马酸伏诺拉生片。结论 富马酸伏诺拉生片在治疗胃食管反流中的疗效、基础酸排出量及不良反应发生率等方面的效果均优异于雷贝拉唑肠溶胶囊,但根据药物经济学成本-效果分析显示雷贝拉唑肠溶胶囊的药物经济学价值更高。     

莫沙必利联合埃索美拉唑对胃食管反流患者胃食管动力学及胃电活动指标的影响研究

目的：研究莫沙必利联合埃索美拉唑对胃食管反流患者胃食管动力学及胃电活动指标的影响。方法选取2012年1月∽2013年12月本院收治的胃食管反流患者110例,根据不同治疗方式分为对照组和观察组各55例,对照组采用埃索美拉唑组治疗,观察组在对照组治疗的基础上给予莫沙必利,分析比较两组患者治疗后3、6、12周的胃食管动力学及胃电参数。结果治疗后3、6、12周,观察组胃动力学指标（胃窦收缩幅度、胃窦运动指数及胃窦收缩频率）、食管动力学指标（食管括〈肌压力、食管括〈肌松弛率及蠕动性收缩比）及胃电活动指标（餐前及餐后的频率及幅值）均显著高于对照组（P〈0.05）,且观察组治疗后胃食管动力学指标及胃电参数呈进行性升高（P〈0.05）。结论莫沙必利联合埃索美拉唑对胃食管反流患者的胃食管动力学及胃电活动指标的影响较大,治疗效果较好。     

胃食管反流病亚型反流特点分析

目的 比较反流性食管炎(RE)、非糜烂性反流病(NERD)、Barretts食管(BE)患者的反流特点.方法 将胃食管反流病(GERD)患者根据内镜表现分为RE、NERD、BE 3组,同步进行食管下段24 h pH及胆红素监测,比较其反流特点.结果 (1)RE、BE组酸暴露指标及中重度酸反流患者比例显著高于NERD组.(2)BE组中病理性反流(82.61%),尤其是酸胆汁混合反流(30.43%)比例明显高于NERD组.(3)无病理性反流的SI+患者酸暴露水平高于SI-患者.结论 酸、胆汁暴露程度差异是造成胃食管反流病患者内镜表现不同的原因之一.     

咽异感症与胃食管反流的关系研究

目的观察研究咽异感症与胃食管反流的关系。方法将2014年2月~2015年2月收治的60例合并胃食管反流病的患者分为两组,每组30例。对照组给予上清片治疗,观察组接受雷贝拉唑+莫沙必利+上清片治疗。应用Synectics Digitrapper便携式p H监测仪和Syn-ectics Bilitec 2000胆汁监测仪进行食管内24h动态p H和胆汁监测,并对两组患者临床疗效进行统计学分析。结果观察组患者的反流率为33.3%,明显低于对照组的66.7%,差异具有统计学意义(P0.05);观察组患者胃食管反流病、咽异感症治疗总有效率分别为86.7%、93.3%,明显高于对照组的76.7%、73.3%,差异具有统计学意义(P0.05)。结论病理性胃食管反流患者可伴有咽异感症,两者具有相关性,给予抑酸治疗后疗效满意,说明胃食管反流病可能是咽异感症的重要病因之一。     

Night-time intra-oesophageal bile and acid: a comparison between gastro-oesophageal reflux disease patients who failed and those who were treated successfully with a proton pump inhibitor

Aliment Pharmacol Ther 2011; 33: 837–844

Summary

Background Little is known about the contribution of bile and acid reflux to night‐time symptoms generation in patients who failed PPI treatment. Aim To compare the degree of night‐time oesophageal acid and bile [by the surrogate duodenogastroesophageal reflux (DGER)] exposure between gastro‐oesophageal reflux disease (GERD) patients who failed and those who fully responded to PPI once a day while on treatment. Methods Gastro‐oesophageal reflux disease patients were assigned to the PPI failure group if they continued to report symptoms ≥3/week and to the PPI success group if they were asymptomatic for the last 3 months while on PPI once a day. All patients underwent upper endoscopy and subsequently simultaneous 24‐h oesophageal Bilitec and pH testing while on PPI treatment. Results Twenty‐three patients were enrolled into the PPI failure group and 24 patients into the PPI success group. The percentage of night‐time pH < 4 and the number of night‐time acid reflux episodes were significantly higher in the PPI failure group as compared with the PPI success group. All night‐time DGER parameters were similar between the PPI failure and PPI success groups. Conclusions Night‐time oesophageal acid exposure is significantly higher in the PPI failure group vs. PPI success group. The degree of night‐time bile reflux is similar in the two groups of patients with GERD.     

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。     

泮托拉唑联合依托必利治疗反流性食管炎的效果观察

目的探讨泮托拉唑联合依托必利治疗反流性食管炎的效果。方法选取2011年9月～2012年12月于本院以奥美拉唑联合依托必利进行治疗的37例反流性食管炎患者为对照组,并将同时期以泮托拉唑联合依托必利进行治疗的37例患者选为观察组,将两组患者治疗1个疗程的总有效率与治疗前、后不同时间的食管动力学指标进行对比。结果观察组治疗1个疗程的总有效率高于对照组,治疗后不同时间的食管动力学指标也优于对照组,差异均有统计学意义（P〈0.05）。结论泮托拉唑联合依托必利治疗反流性食管炎的效果较好,更有助于改善食管动力学指标。     

Tenatoprazole, a novel proton pump inhibitor with a prolonged plasma half-life: effects on intragastric pH and comparison with esomeprazole in healthy volunteers

BACKGROUND: Proton pump inhibitors control gastric acidity better during the day than at night, when nocturnal acid breakthrough can occur. Tenatoprazole is a novel proton pump inhibitor with a seven-fold longer plasma half-life. Aim : To compare the effects of tenatoprazole 20 mg (T20), tenatoprazole 40 mg (T40) and esomeprazole 40 mg (E40) on intragastric acidity in healthy volunteers. METHODS: This randomized, three-period, cross-over study enrolled 18 Helicobacter pylori-negative volunteers, who received E40, T20 and T40 once daily for 7 days with a 14-day washout between periods. Twenty-four-hour gastric pH monitoring was performed on day 7. Serum gastrin was assessed on day 8. RESULTS: T40 induced a more potent acid inhibition than T20 (24-h median pH: 4.6 vs. 4.0, P < 0.01; daytime: 4.5 vs. 3.9, P < 0.01; night-time: 4.7 vs. 4.1, P < 0.05). T40 was more potent than E40 (24-h median pH: 4.6 vs. 4.2, P < 0.05; night-time: 4.7 vs. 3.6, P < 0.01); the pH > 4 holding time was higher during the night for T40 than for E40: 64.3% vs. 46.8%, P < 0.01; the nocturnal acid breakthrough duration was significantly shorter for T40 than for E40. No significant gastrin increase was observed and all drugs were well tolerated. CONCLUSION: T40 is significantly more potent than T20 and E40 during the night. The therapeutic relevance of this pharmacological advantage deserves further study.     

广泛性焦虑患者心率变异性昼夜变化的临床分析

目的探讨广泛性焦虑（GAD）患者心率变异性（HRV）昼夜节律变化。方法选取43例GAD患者为研究组,43例健康成人为对照组,两组均进行24 h动态心电图监测及HRV分析。结果研究组各项HRV时域指标均明显低于对照组,差异有统计学意义（P〈0.05）,研究组白天与夜间SDNN、SDANN、rMSSD、PNN50比较,差异无统计学意义（P〉0.05）。对照组白天与夜间比较,四个指标差异均有显著统计学意义（P〈0.01）。结论 GAD患者存在自主神经功能紊乱,昼夜节律性消失,以迷走神经张力下降,交感神经张力相对亢进为主要表现。     

肥胖与食管动力障碍及酸反流的相关性研究

目的：探讨肥胖与下食管括约肌压力（LESP）、食管体部远端收缩压及酸反流之间的关系。 方法：对146例患者进行胃食管反流病（GERD）症状问诊、标准食管测压及24 h食管动态pH监测,分为GERD组和对照组。每组根据体重指数（BMI）又分为非肥胖组（BMI≤27.9 kg/m2）及肥胖组（BMI≥28 kg/m2）。 结果：GERD组中,肥胖者的LESP高于非肥胖者（16.4±4.7 vs. 14.4±3.2 mmHg,P=0.014）。对照组与GERD组两组中的肥胖者的食管体部远端收缩压均显著高于非肥胖者（对照组：107±48 vs. 77±20 mmHg,P=0.04;GERD组：98±44 vs. 79±39 mmHg,P=0.017）。对照组中,肥胖者胡桃夹食管发生率显著高于非肥胖者（25% vs. 0,P=0.031）。GERD组中,肥胖者中无效食管运动（IEM）的发生率显著低于非肥胖者（7% vs. 20%,P=0.035）。两组中肥胖者pH＜4时间百分比均高于非肥胖者（对照组：pH＜4总时间百分比3.0%（0.9~5.6） vs. 1.3%（0.3~2.7）,P=0.003;GERD组：立位pH＜4时间百分比13.2%（5.1~19.2） vs. 10.4%（2.9~18.1）,P=0.001）。BMI与pH＜4时间百分比（P＜0.001）、食管体部远端收缩压（P=0.007）、和LESP（P=0.006）呈正相关。 结论：肥胖者与非肥胖者在食管生理学检查中存在多方面差异,肥胖者的食管动力更强,食管pH＜4时间百分比更高。     

食管动力异常与胃食管反流病的相关性研究

目的探讨食管动力异常与食管黏膜损害及酸反流发生的临床相关性。方法选择笔者所在医院2011年6月～2012年6月收治的符合胃食管反流病诊断标准的148例患者以及15名其他受试者纳入研究,均接受食管压力和食管24hpH值测定,GERD患者根据压力分组,其他受试者纳入对照组,对所有受试者食管压力以及24h食管pH值进行比较分析。结果 52例(35.1%)患者符合下食管括约肌低压标准,49例(33.1%)患者符合食管无效动力标准,33例(22.3%)患者两项均符合,14例(9.5%)患者两项均不符合。对照组的LESP要显著高于其他四组,差异有统计学意义(P<0.05);C组在远端反流指数、总反流时间、最长反流时间和EAC方面均显著高于A、B和D组,差异有统计学意义(P<0.05);B和C组在pH<4总时间百分比、立位pH<4时间百分比和卧位pH<4时间百分比方面显著高于其他3组,差异有统计学意义(P<0.05),而B和C组间差异无统计学意义(P>0.05)。结论胃食管反流病的发生与多因素有关,下食管括约肌低压和食管无效动力都是诱发因素之一,其中反流性食管炎的程度与酸反流密切相关,而与食管无效动力无相关性。     

食管癌术后残余食管和胸腔胃运动功能对胃食管反流的影响

目的探讨食管癌术后残余食管和胸腔胃运动功能改变对胃食管反流的影响。方法定期对食管中段癌术后患者46例(A组)进行食管测压、显示子胃排空和24-h食管pH监测,结果与健康志愿者11例(B组)作比较。结果 A组手术后和术后12个月残余食管和胸腔胃运动功能均低于B组(P<0.01和P<0.05)。A组胸胃排空率与DeMeester评分之间以及长于5min反流评分与残余食管原发蠕动幅度、蠕动次数之间均无相关关系(P>0.05)。结论食管癌术后胸腔胃和残余食管运动功能的恢复不足以减轻胃食管反流以及改善食管酸清除功能。     

Effect of splitting the dose of esomeprazole on gastric acidity and nocturnal acid breakthrough

BACKGROUND: Twice-daily dosing is increasingly used to improve gastric acid control, although not all proton-pump inhibitors are more effective when doses are split. Standard dose esomeprazole provides better gastric acid control than other standard dose proton-pump inhibitors. AIMS: To compare the effect of standard dose esomeprazole (1 x 40 mg) with 20 mg b.d. on gastric acidity. METHODS: Thirteen healthy subjects participated in this crossover study, receiving esomeprazole 2 x 20 mg and 1 x 40 mg for 7 days in random order with a washout period of at least 7 days. Gastric 24-h pH was measured on days 1, 2 and 6. RESULTS: Median gastric 24-h pH was higher during 2 x 20 mg esomeprazole on day 2 (P < 0.01), no differences were detected on day 6. Night-time gastric acid suppression was significantly improved by 2 x 20 mg esomeprazole on all study days (P < 0.05). Nocturnal acid breakthrough was observed on all study days in subjects receiving 1 x 40 mg, but in only 85% (first night), 64% (second night), and 45% of subjects (sixth night) with 2 x 20 mg (P < 0.05). CONCLUSION: Splitting the esomeprazole dose improves initial acid suppression, this effect starts at the first night. Maximal benefit is achieved on day 2, while the effect on night-time acid control is detectable during the entire first week of treatment.     

Influence of pantoprazole on oesophageal motility, and bile and acid reflux in patients with oesophagitis

BACKGROUND: Reflux of duodeno-gastric juice into the oesophagus appears to be involved in the pathogenesis of both reflux oesophagitis and oesophageal adenocarcinoma. Although proton pump inhibitors have been shown to decrease acid reflux and heal oesophagitis, their effect on biliary reflux and motility is less clear. AIM: To investigate whether pantoprazole also reduces bile reflux and whether this is paralleled by a change in oesophageal motility. METHODS: Combined 24-h measurements of intraoesophageal bilirubin concentration, pH and pressure were performed in 18 symptomatic patients with endoscopically proven reflux oesophagitis before and on day 28 of treatment with pantoprazole, 40 mg/day, under standardized conditions. A reflux symptom score was determined initially and every 2 weeks thereafter. After 56 days on medication, a control endoscopy was performed. RESULTS: The symptom score and the acid and bile reflux improved significantly, whereas the motility parameters did not change during the study period. Helicobacter pylori-positive patients had a significantly higher bile reflux time (32.1 +/- 4.3%) than H. pylori-negative patients (16.3 +/- 3.1%) (P=0.009). The endoscopic healing rate was 89%. The cough symptoms disappeared in three of four patients. CONCLUSIONS: The proton pump inhibitor pantoprazole decreases both acid and bile reflux. The decrease of bile reflux cannot be explained by increased oesophageal clearance as oesophageal motility did not improve with therapy. Interestingly, H. pylori infection of the stomach was associated with higher levels of oesophageal bile reflux.