The role of proton-pump inhibitor therapy in patients with gastroesophageal reflux disease and difficult-to-control asthma

Difficult-to-control asthma is a frustratingly difficult condition to treat. Many factors contribute to this condition, including gastroesophageal reflux disease. Response to potent acid suppressive therapy with proton-pump inhibitors is less than universal or complete, and underlines the multifactorial nature of the disease. However, the authors of this paper feel strongly that, whereas gastroesophageal reflux disease can be reliably identified, patients with difficult-to-control asthma will experience an improvement in symptoms when treated with acid-suppressive therapy, while bearing in mind that other contributory factors may have to be eliminated at the same time.     

Gastroesophageal reflux disease in children with asthma: treatment implications

An association between asthma and gastroesophageal reflux disease (GERD) has long been recognized both mechanistically and epidemiologically. The clinical relevance of this interplay continues to be explored, with special interest given to the role of GERD in the worsening of asthma. The effect of GERD is most frequently contemplated in patients with asthma that is difficult to control. Medical and surgical anti-reflux trials attempting to alter asthma symptoms have reported mixed but generally underwhelming results, although asthma symptom scores are generally improved following effective treatment of GERD. Many of the pharmaceutical studies can be criticised for having too short a duration or for likely incomplete acid suppression. Few trials have specifically studied pediatric populations. Because GERD is a common condition, particularly in young children, the role reflux plays in the worsening of asthma symptoms and the potential benefit on asthma of anti-reflux therapy warrants further exploration. Whether or not treating symptomatic GERD reduces the symptoms and severity of asthma in children, GERD coexisting with asthma should be aggressively treated. GERD symptoms in most patients with or without asthma can be controlled medically with continuous use of proton pump inhibitors such as omeprazole and lansoprazole and to a lesser extent by histamine H(2) receptor antagonists such as famotidine and cimetidine.     

食管外表现为主要症状的胃食管反流病32例

目的提高对胃食管反流病的诊治水平。方法对2003-2013年我们收治的以食管外表现为主要症状的32例胃食管反流病患者临床资料进行分析总结。结果本组均无典型胃食管胃反流症状,主要表现慢性咳嗽14,哮喘5例,非心源性胸痛11例,咽部不适2例,确诊前病程2~39个月,经确诊胃食管反流病给予相应治疗后,症状均有明显好转。结论对于久治不愈的慢性咳嗽、哮喘、心绞痛样胸痛、咽部不适等症状的患者,应考虑胃食管反流病的可能,提高对该病的诊治水平。     

Role of gastroesophageal reflux disease in asthmatic patients

The association between gastroesophageal reflux disease (GERD) and asthma is well accepted. The prevalence of GERD increases in asthmatics compared with normal controls, whereas GERD may induce or exacerbate asthma. They interact with each other in a cause and effect relationship. But the mechanism by which GERD might induce or aggravate asthmatic symptoms remains unclear. Two mechanisms have been proposed, including (1) acid in the inflamed esophagus acting on exposed receptor causes an increase in bronchial hyper-responsiveness via the vagal reflex; (2) microaspiration of gastric contents damage the bronchial mucosa, which result in inflammation of the mucosa and bronchial hyper-responsiveness. Among the GERD diagnostic methods, ambulatory esophageal pH monitoring bears the highest sensitivity. Ambulatory esophageal pH monitoring is recommended in patients without classic reflux symptoms or those with difficult to control asthma. Both medical and surgical antireflux therapy could improve asthma symptoms, asthma medication requirements, and even pulmonary function in a proportion of asthmatics.     

以呼吸道疾病为主要症状的胃食管反流病临床分析37例

目的通过以呼吸道疾病为主要症状的胃食管反流病的诊断,总结永煤集团总医院胃食管反流病诊断治疗的经验。方法永煤集团总医院2007年1月至2009年12月收治胃食管反流病97例,对其中以呼吸道疾病为主要诊断的37例(误诊为支气管炎19例,哮喘6例,慢性咽炎8例、肺炎4例)经胃镜检查确诊为反流性食管炎(A级10例,B级20例,C级7例)的患者进行回顾性分析。结果所有就诊病例均给予6周PPI制酸及胃肠动力药物治疗,继发呼吸道感染者给予短期抗感染等对症治疗,6周后咳嗽等症状均消失。结论临床医师在胃食管反流病的诊疗过程中应注意其呼吸系统的症状,提高诊疗水平。     

精神心理因素与胃食管反流病临床观察

目的 通过分析精神心理因素对不同类型的胃食管反流病的影响,了解精神心理卫生因素与胃食管返流病的临床相关性.方法 我院于2010年5月至2011年5月治疗的胃食管反流病患者98例,根据其不同的类型分为反流性食管炎组和非糜烂性食管病组,比较两组患者出现心理异常的情况.结果 两组患者中非糜烂性食管病组的患者发生精神心理异常率达到82.0%,高于反流性食管炎组的52.1%,差异有统计学意义(P<0.05),非糜烂性食管病组的患者抑郁评分和焦虑评分分别为(54.34±10.53)和(46.73±6.71),高于反流性食管炎组的(47.31±9.61)和(41.65±7.24),两组比较,差异有统计学意义(P<0.05).结论 精神心理因素在胃食管反流病的发病中起着重要的作用,尤其是在非糜烂性食管病患者中,对其的影响高于反流性食管炎的患者.     

Update on the pharmacogenomics of proton pump inhibitors

Proton pump inhibitors (PPIs) are widely used for the treatment of gastroesophageal reflux disease as well as other acid-related disorders. PPIs are metabolized primarily via the CYP2C19 and CYP3A4 isoenzymes; their activity is influenced both by exogenous and endogenous (pharmacogenetic) factors. The CYP2C19 polymorphism affects the metabolism of PPIs, causing large individual pharmacokinetic variations. Differences in the CYP2C19-mediated metabolism can produce marked interpatient variability in acid suppression, in drug-interaction potential and in clinical efficacy. Understanding the pharmacokinetic properties of PPIs and examining the pharmacogenetic alterations may help clinicians optimize PPI therapy and administer individual treatment, especially to nonresponder patients with gastroesophageal reflux disease or ulcer or after failed eradication therapy.     

Rabeprazole: a pharmacologic and clinical review for acid-related disorders

Rabeprazole is a proton pump inhibitor that can be used in the treatment of acid-peptic-related disorders (gastroesophageal reflux disease [GERD], duodenal ulcer, gastric ulcer, gastric acid hypersecretory syndromes) and Helicobacter pylori. Pharmacodynamic data has demonstrated that rabeprazole, with a high pKa of ～ 5.0, can be activated at a higher pH than other proton pump inhibitors. This possibly results in faster onset of action. Owing to its non-enzymatic pathway of metabolism, rabeprazole is also less influenced by genetic polymorphisms of the CYP2C19, which others proton pump inhibitors are dependent on. In a 2-week, placebo-controlled trial, rabeprazole was both rapid and effective in relieving heartburn on day 1 of therapy and improved other GERD-related symptoms including regurgitation, belching, bloating, early satiety and nausea. For oesophageal reflux disease without erosions both 10 and 20 mg of rabeprazole are equivalent and better than placebo at 2 and 4 weeks. An on-demand approach to non-erosive reflux disease with 10 mg of rabeprazole has also been documented as superior to placebo. Some success in the treatment of extra-oesophageal manifestations of GERD, such as asthma and chronic laryngitis, has also been achieved with rabeprazole. Overall, rabeprazole with very few side effects is a safe and efficacious medication for acid suppression therapy.     

胆碱能药物在胃食管反流性哮喘治疗中的策略

胃食管反流与哮喘的发生有着密切的联系。实验证实迷走神经在食管-支气管哮喘的发生中起一定的作用,而胆碱能神经递质和胆碱受体可能在胃食管反流性哮喘的发病机制中占有重要的地位,提示抗胆碱能药物在胃食管反流性哮喘的治疗过程中具有潜在的应用前景。     

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。     

Gastroesophageal reflux disease

Gastroesophageal reflux disease is a common disorder in which irritant gastric contents enter the esophagus, most commonly via transient lower esophageal sphincter relaxation. The diagnosis of gastroesophageal reflux disease may be made on clinical grounds alone or may be confirmed with studies including esophagogastroduodenoscopy or ambulatory pH monitoring. There are a number of different medications to treat reflux disease, including histamine-2 receptor antagonists, promotility agents and the proton pump inhibitors. Reflux disease often requires chronic maintenance therapy.     

雷贝拉唑联合铝碳酸镁治疗胃食管反流病的疗效分析

目的评价雷贝拉唑联合铝碳酸镁治疗胃食管反流病的临床疗效。方法选取2010年8月至2013年10月收治的胃食管反流病患者40例,随机分为两组,其中观察组20例,采用雷贝拉唑联合铝碳酸镁治疗;对照组20例,采用奥美拉唑联合阿莫西林治疗。用药4周后观察并比较两组患者的反流症状改善程度和食管pH变化。结果观察组反流症状消失19例（95．0％）,反流症状不消失1例（5．0％）;对照组反流症状消失14例（70．0％）,反流症状不消失6例（30．0％）,两组患者反流症状改善程度比较差异有统计学意义（P〈0．05）。食管pH〈4观察组2例（10．0％）,对照组5例（25．0％）;食管pH〉4观察组18例（90．0％）,对照组15例（75％）,两组患者食管pH值变化比较差异有统计学意义（P〈0．05）。结论雷贝拉唑联合铝碳酸镁治疗胃食管反流病的临床疗效好,值得在临床上予以推广。     

Not asthma,but GERD:case report

Asthma is a disorder of the lungs characterized by increased responsiveness of the airways, as manifested by episodes of wheezing and increased resistance to expiratory airflow because of varying degrees of smooth muscle contraction, edema of the mucosa, and mucus in the lumen of the bronchi and bronchioles. The stimuli vary widely and include antigens, infection, air pollutants, respiratory tract irrtants, exercise, and emotional factors. This condition is completely different from distress breathing because of laryngotracheal spasm. One of its causes is the gastric content reflux through the pharynx to the larynx because of gastroesophageal reflux disease (GERD), in addition to the typical human avian flu that may cause immediate suffocation by laryngospasm owing to acute larygotrachitis. A patient suffered from GERD without esophageal symptoms, which was diagnosed and treated as bronchial asthma during his five emergency admissions. The admissions were because of episodic attacks of severe air hunger owing to an extreme throat tightening. The patient was being treated for as long as two years. After the correct diagnosis was made and treatment of laporascopic fundaplication was performed, the longstanding “bronchial asthma”, after all, completely disappeared. The concept of “not asthma, but GERD” seems undervalued, unappreciated, even misunderstood among patients with intractable asthma. Therefore, such a case is reported in detail, similar cases are mentioned briefly as well, and a mechanism responsible for GERD-originated larryngo-or laryngotracho-spasm is proposed.     

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。     

胃食管返流与支气管哮喘

抗原吸入是外源性哮喘的一个常见原因，经脱敏疗法已使部份哮喘患者恢复了健康。但部分外源性哮喘并无特异性的刺激因素也出现支气管收缩；相当部分内源性哮喘息者按常规治疗效果也不满意。近年来国外研究表明，胃食管返流（GER）是诱发或加重哮喘的一个重要因素，这一发现对哮     

中医内科治疗胃食管反流病的临床分析

目的探讨中医内科治疗胃食管反流病临床疗效。方法将我院收治的胃食管反流病患者92例随机分为观察组与对照组,其中对照组采用临床西药常规疗法,观察组在此基础上给予自拟中药复方治疗,2个疗程后比较两组患者临床疗效。结果治疗2个疗程后,观察组总有效率为93.6%,对照组总有效率为80.0%,组间比较具有显著性差异(P<0.05)。结论采用中医内科治疗胃食管反流病临床疗效确切,显著提高临床有效率,值得临床进一步深入研究及推广应用。     

大环内酯类抗生素在儿科常见病中的应用

目的评价大环内酯类抗生素治疗儿科常见病的疗效。方法儿科门诊及住院治疗的患儿32例,根据病情给予吸氧、吸痰、降温、对症处理等基础治疗上,分别给予大环内酯类药物治疗。结果经治疗后上呼吸道感染有效率为88.8%,下呼吸道感染有效率为83.3%,过敏性紫癜有效率100%,儿童再发性腹痛有效率66.7%,胃食管反流有效率50.0%,支气管哮喘有效率100%。结论大环内酯类抗生素不仅具有较强的抗菌功能,还能有效治疗非感染性疾病。     

Combined use of omeprazole and a novel antioxidative cytoprotectant for the treatment of peptic ulcer. Facilitation of ulcer healing in experimental animals

Peptic ulcer and gastroesophageal reflux are common acid-peptic related diseases. The pathophysiology of peptic ulcer disease has been centered on an imbalance between aggressive and defensive factors. This study was conducted to examine whether the combined use of omeprazole (CAS 73590-58-6), a proton pump inhibitor, and DA-9601, a novel anti-ulcer formulation of the extract of Artemisia asiatica Nakai, has synergistic effects on various peptic ulcers and gastroesophageal reflux diseases in animal models. An optimal combination ratio of omeprazole and DA-9601 was investigated in an acetic acid-induced ulcer model. In the results, oral pretreatment with omeprazole and DA-9601 (combination ratio, 1:3) significantly reduced alcohol-, indometacin-, acetic acid-, and cysteamine-induced gastrointestinal lesions in a synergistical manner in rats. The combination treatment also significantly attenuated the gross and histopathological lesions in an experimental reflux esophagitis model as compared to the single treatment of omeprazole or DA-9601. In an alcohol-induced gastritis model, the combined treatment resulted in a significant decrease in lipid peroxidation with concomitant increases in glutathione content and prostaglandin E2 level, which was proportional to the inhibitory effect of the combination therapy. These results suggest that the combined therapy with omeprazole and DA-9601, a cytoprotectant, can be beneficial for the treatment of peptic ulcer and reflux esophagitis.     

南平市胃食管反流病流行病学分析

目的 探讨胃食管反流病（GERD） 可能的发病危险因素,了解GERD 与呼吸道、口咽部疾患的关系.方法对南平地区1982 名18 岁以上居民进行中文版反流疾患的问卷调查.结果 GERD 症状发病率为6.77%,GERD 组伴发呼吸道、口咽部疾患的比例明显高于非GERD 组,两组比较差异有统计学意义;反酸、烧心和反食均为发生GERD 的危险性指标.结论 胃食管反流病发病与多种因素有关,需要采取有效的干预措施;反酸、烧心、反食可以作为预测胃食管反流病发病概率的三项重要指标.     

X线钡餐造影对胃食管反流病的诊断价值

目的：探讨X线钡餐造影对胃食管反流病的诊断价值,为临床提供依据。方法选取本院2013年1月-2014年1月消化内科收治的胃食管反流病病例50例,对其进行回顾性分析和X线诊断检查征象的观察,并分析患者的反流情况。结果 X线钡餐造影诊断胃食管反流病,能对患者反流的程度、形式、清除情况和并发症进行分析。结论 X线钡餐造影的检查方法,能直接发现胃食管反流病,且操作简便易于患者接受,对临床胃食管反流病的诊断和治疗有着十分重要的参考价值。