奥美拉唑治疗前后糜烂性食管炎患者食管鳞状上皮细胞间隙的变化

目的观察糜烂性食管炎患者应用奥美拉唑治疗前后食管鳞状上皮细胞间隙的改变。方法20例经胃镜确诊的糜烂性食管炎患者给予奥美拉唑20mg,2次／d,治疗4周后复查胃镜。治疗前后2次胃镜检查时于齿状线上方2cm取活检,观察透射电镜下鳞状上皮细胞间隙的变化。治疗前后患者分别接受症状问卷,症状严重程度用积分表示。结果治疗前平均细胞间隙、最大细胞间隙和最小细胞间隙分别为（1．14±0．15）μm、（1．47±0．15）μm、（0．85±0．17）μm;治疗后分别为（O．51±0．18）μm、（0．72±0．25）μm、（0．36±0．15）μm,与治疗前比较差异有统计学意义（P=0．000）。结论短期应用奥美拉唑治疗可以使糜烂性食管炎患者增宽的食管下段鳞状上皮细胞间隙恢复至正常。     

Shape of Barrett's epithelium is associated with prevalence of erosive esophagitis

AIM:To test the hypothesis that the shape and length of Barrett‘s epithelium are associated with prevalence of erosive esophagitis.METHODS:A total study population comprised 869 patients who underwent endoscopy during a health checkup at our hospital.The presence and extent of Barrett‘s epithelium were diagnosed based on the Prague C & M Criteria.We originally classified cases of Barrett‘s epithelium into two types based on its shape,namely,flamelike and lotus-like Barrett‘s epithelium,and into two groups b...     

反流性食管炎及非糜烂性胃食管反流病超微结构比较

目的研究反流性食管炎与非糜烂性胃食管反流病（NERD）超微结构的特点。方法随机选取反流性疾病诊断问卷调查评分（Sc）在12分以上的13例患者，经胃镜检查7例诊断反流性食管炎（A组），6例诊断NERD（B组），两组患者均取食管病理组织行透射电镜检查，其中7例患者行食管测压和24h食管pH监测检查。结果反流性疾病诊断问卷提示A、B两组患者症状评分差别无统计学意义；24h食管pH监测A组患者较B组患者存在较多的病理性酸反流；而A、B两组患者食管鳞状上皮细胞间隙增宽程度接近。结论胃食管反流患者均存在不同程度细胞间隙增宽，细胞间隙增宽可能导致NERD患者对生理性酸反流的高敏感性。     

Prevalence of Barrett＇s esophagus in patients with moderate to severe erosive esophagitis

AIM： To investigate the proportion of patients with moderate-severe erosive esophagitis （EE） who will have Barrett＇s esophagus （BE） after healing of inflammation.
METHODS： Patients with EE of Los Angeles （LA） class B, C and D who underwent follow-up endoscopy documenting complete mucosal healing.
RESULTS： A total of 86/169 patients were suspected of having BE （38 before healing and 48 after healing of EE） and, 46/86 eventually had the histological confirmation. At index esophago-gastro-duodenoscopy （EGD）, BE was suspected in 38/169 （22%）, and ultimately, histologically confirmed in 20 of these. In 11 patients where biopsies were performed in the presence of inflammation, BE was detected in 2 and missed in 5 （including 2 dysplasias）. In 131/169 patients （77.5%）, BE was not suspected at index EGD. After healing of EE though, 48 patients had suspicion of BE who underwent biopsies, and in 26 of these histology was positive for BE. The length of inflammation had a linear correlation with the length of BE （P = 0.01）. Out of multiple variables to predict BE, only the suspicion at index endoscopy was statistically significant （P = 0.01）.
CONCLUSION： BE was seen in 46/169 （27%） patients with EE of LA class B, C and D. The length of EE can predict the length of underlying BE segment.Even when suspected, BE and associated dysplasia can be missed in the presence of inflammation; therefore, repeat evaluation should be considered after complete healing of esophagitis.     

奥美拉唑、泮托拉唑、兰索拉唑和埃索美拉唑对反流性食管炎患者症状缓解的比较研究

目的比较奥美拉唑、泮托拉唑、兰索拉唑和埃索美拉唑对反流性食管炎患者症状缓解之间的差异。方法320例内镜诊断为反流性食管炎患者被随机分为4组,并分别服用奥美拉唑20mg,1次／d,8周;兰索拉唑30mg,1次／d,8周;泮托拉唑40mg,1次／d,8周;埃索美拉唑40mg,1次／d,8周。用six—point scale（0：无,1：轻度,2：轻度-中度,3：中度,4：中度-重度,5：重度）评价服用4种质子泵抑制剂后7天内的烧心和反流症状。结果埃索美拉唑组的平均烧心积分比其他质子泵抑制剂下降更迅速。埃索美拉唑组第1～5天的烧心症状完全消失率明显高于奥美拉唑组（P值分别为0．0054、0．0072、0．0089、0．0107、0．0134）、兰索拉唑组（P值分别为0．0043、0．0034、0．0044、0．0011、0．0052）、泮托拉唑组（P值分别为0．0156、0．0003、0．0005、0,0024、0．0172）。内镜下反流性食管炎愈合率4组之间无明显差异。结论埃索美拉唑比奥美拉唑、兰索拉唑、泮托拉唑更迅速地减轻反流性食管炎患者的烧心和反流症状。     

Esomeprazole versus other proton pump inhibitors in erosive esophagitis: a meta-analysis of randomized clinical trials.

BACKGROUND & AIMS: There are limited data comparing the effectiveness of available proton pump inhibitors (PPIs) in erosive esophagitis (EE). We performed a meta-analysis to calculate the pooled effect of esomeprazole on healing rates, symptom relief, and adverse events versus competing PPIs in EE. METHODS: We performed a structured electronic search of MEDLINE and EMBASE and reviewed published abstracts to identify English-language, randomized clinical trials from 1995-2005, comparing rates of endoscopic healing, symptom relief, and adverse events with esomeprazole versus alternative PPIs in the treatment of gastroesophageal reflux disease (GERD)/EE. We then performed meta-analysis to compare the relative risk (RR) of EE healing, symptom relief, and adverse events between study arms and calculated the absolute risk reduction and number needed to treat (NNT) for each outcome. RESULTS: Meta-analysis was performed on 10 studies (n=15,316). At 8 weeks, there was a 5% (RR, 1.05; 95% confidence interval, 1.02-1.08) relative increase in the probability of healing of EE with esomeprazole, yielding an absolute risk reduction of 4% and NNT of 25. The calculated NNTs by Los Angeles grade of EE (grades A-D) were 50, 33, 14, and 8, respectively. Last, esomeprazole conferred an 8% (RR, 1.08; 95% confidence interval, 1.05-1.11) relative increase in the probability of GERD symptom relief at 4 weeks. CONCLUSIONS: As compared with other PPIs, esomeprazole confers a statistically significant improvement, yet, clinically, only a modest overall benefit in 8-week healing and symptom relief in all-comers with EE. The clinical benefit of esomeprazole appears negligible in less severe erosive disease but might be important in more severe disease.     

Comparative study of omeprazole, lansoprazole, pantoprazole and esomeprazole for symptom relief in patients with reflux esophagitis

AIM： To clarify whether there is any difference in the symptom relief in patients with reflux esophagitis following the administration of four Proton pump inhibitors （PPIs）. METHODS： Two hundred and seventy-four patients with erosive reflux esophagitis were randomized to receive 8 wk of 20 mg omeprazole （n = 68）, 30 mg of lansoprazole （n = 69）, 40 mg of pantoprazole （n = 69）, 40 mg of esomeprazole （n = 68） once a day in the morning. Daily changes in heartburn and acid reflux symptoms in the first 7 d of administration were assessed using a six-point scale （0： none; 1： mild; 2： mild-moderate; 3： moderate; 4： moderate-severe; 5： severe）. RESULTS： The mean heartburn score in patients treated with esomeprazole more rapidly decreased than those receiving other PPI. Complete resolution of heartburn was also more rapid in patients treated with esomeprazole for 5 d compared with omeprazole （P = 0.0018, P = 0.0098, P = 0.0027, P = 0.0137, P = 0.0069, respectively）, lansoprazole （P = 0.0020, P = 0.0046, P = 0.0037, P = 0.0016, P = 0.0076, respectively）, and pantoprazole （P = 0.0006, P = 0.0005, P = 0.0009, P = 0.0031, P = 0.0119, respectively）. There were no significant differences between the four groups in the rate of endoscopic healing of reflux esophagitis at week 8. CONCLUSION： Esomeprazole may be more effective than omeprazole, lansoprazole, and pantoprazole for the rapid relief of heartburn symptoms and acid reflux symptoms in patients with reflux esophagitis.     

Esomeprazole (40 mg) compared with lansoprazole (30 mg) in the treatment of erosive esophagitis

OBJECTIVES: Esomeprazole, the S isomer of omeprazole, has been shown to have higher healing rates of erosive esophagitis than omeprazole. This study compared esomeprazole with lansoprazole for the healing of erosive esophagitis and resolution of heartburn. METHODS: This United States multicenter, randomized, double blind, parallel group trial was performed in 5241 adult patients (intent-to-treat population) with endoscopically documented erosive esophagitis, which was graded by severity at baseline (Los Angeles classification). Patients received 40 mg of esomeprazole (n = 2624) or 30 mg of lansoprazole (n = 2617) once daily before breakfast for up to 8 wk. The primary efficacy endpoint was healing of erosive esophagitis at week 8. Secondary assessments included proportion of patients healed at week 4, resolution of investigator-recorded heartburn, time to first and time to sustained resolution of patient diary-recorded heartburn, and proportion of heartburn-free days and nights. RESULTS: Esomeprazole (40 mg) demonstrated significantly higher healing rates (92.6%, 95% CI = 91.5-93.6%) than lansoprazole (30 mg) (88.8%, 95% CI = 87.5-90.0%) at week 8 (p = 0.0001, life-table estimates, intent-to-treat analysis). A significant difference in healing rates favoring esomeprazole was also observed at week 4. The difference in healing rates between esomeprazole and lansoprazole increased as baseline severity of erosive esophagitis increased. Sustained resolution of heartburn occurred faster and in more patients treated with esomeprazole. Sustained resolution of nocturnal heartburn also occurred faster with esomeprazole. Both treatments were well tolerated. CONCLUSIONS: Esomeprazole (40 mg) is more effective than lansoprazole (30 mg) in healing erosive esophagitis and resolving heartburn. Healing rates are consistently high with esomeprazole, irrespective of baseline disease severity.     

埃索美拉唑联合莫沙比利治疗吻合口溃疡的临床研究

目的 探讨埃索美拉唑联合莫沙比利、克拉霉素、阿莫西林治疗幽门螺杆菌(Hp)相关吻合口溃疡的效果.方法 将94例患者随机分为两组:治疗组48例,对照组46例.治疗组采用埃索美拉唑40mg每日1次,早晨空腹服用,莫沙比利5 mg每日3次,克拉霉素500 mg每日2次,阿莫西林1.0g每日2次,疗程1周;1周后继续口服埃索美...     

Prevalence of asymptomatic erosive esophagitis and factors associated with symptom presentation of erosive esophagitis

Abstract

Objective. Asymptomatic erosive esophagitis (EE) is incidentally found during endoscopy for health screening. The authors have aimed to investigate the prevalence of asymptomatic EE in subjects undergoing health checkups and factors associated with symptom presentation of EE. Methods. Among the consecutive 13,342 adults who underwent esophagogastroduodenoscopy in health checkup programs of Ajou University Hospital from May 2010 to April 2011, 8840 subjects (5683 men and 3157 women; median age, 45 years) who met the enrollment criteria were included in the analysis. They completed a questionnaire that evaluated smoking, medication history, anxiety, depression, esophagopharyngeal symptoms, and dyspeptic symptoms. The mucosal damage of the esophagus was assessed using the Los Angeles classification system. Individuals who had EE but no esophagopharyngeal symptoms were classified into the asymptomatic EE group. Results. A total of 768 subjects were diagnosed with gastroesophageal reflux disease based on the occurrence of heartburn and/or acid regurgitation at least once a week. The prevalence of symptomatic and asymptomatic EE in 8840 subjects was 4.3% and 3.3%, respectively. About 43% of individuals with EE did not exhibit any esophagopharyngeal symptoms. Male gender and postprandial distress syndrome were independently associated with asymptomatic EE. Male gender, current smoking, anxiety, epigastric pain syndrome (EPS), and postprandial distress syndrome were independently associated with symptomatic EE. Compared with the asymptomatic EE group, anxiety and EPS were independent factors associated with symptomatic EE. Conclusions. Asymptomatic EE is common in subjects undergoing a health checkup. The coexistence of anxiety or EPS appears to be the predictors for the symptom presentation of EE.     

埃索美拉唑根除幽门螺杆菌的Meta分析

目的 综合评价基于埃索美拉唑的三联疗法根除幽门螺杆菌(Hp)的作用.方法 对基于埃索美拉唑的三联疗法根除Hp并以其他质子泵抑制剂以及自身不同剂量作为对照的随机对照试验(RCT)进行Meta分析.结果 有8项RCT比较了基于埃索美拉唑和奥美拉唑的二联疗法的Hp根除率,有2项研究比较了埃索美拉唑80 mg/d与40mg.d的Hp根除率.基于意向治疗分析的结果显示,试验组Hp根除率为84.8%,对照组为82.0%,差异无统计学意义(OR 1.24.95%CI:0.96～1.60,P:0.10).基于按方案分析的结果显示,试验组Hp根除率为88.0%,对照组为85.1%,差异无统计学意义(OR 1.30,95%CI:0.97～1.74,P=0.07).分别埘高质量研究和疾病谱为十二指肠溃疡的研究进行分析,两组Hp根除率无统计学筹异.对疾病谱为消化小良的研究进行分析,按方案分析显示,试验组Hp根除率显著高于对照组(P=0.02),但意向治疗分析未显示统计学差异(P=0.06).埃索美拉唑剂量分别为80 mg/d与40mg.d的两纽的Hp根除率无统计学筹异.结论 基于埃索美拉唑的三联疗法能有效清除Hp感染,但并不优于奥美拉唑,也有足够证据支持增加剂量能提高Hp根除率的观点.对于伴Hp感染的消化不良患者,基丁埃索美拉唑的二三联疗法的清除Hp作用可能要优于奥美拉唑.     

埃索美拉唑治疗反流性食管炎的疗效观察

质子泵抑制剂（PPI）是目前治疗反流性食管炎（RE）最有效的药物之一，埃索美拉唑是新一代PPI，其控制胃酸分泌的能力比其它PPI作用更强、更快，且持续时间更长，用于治疗RE取得较好的临床效果。本研究旨在通过比较埃索美拉唑与兰索拉唑治疗RE的疗效，探索埃索美拉唑治疗RE的临床应用价值。     

Esomeprazole 40 mg administered intravenously has similar safety and efficacy profiles to the oral formulation in patients with erosive esophagitis

BACKGROUND/AIMS: An intravenous formulation of esomeprazole has been developed for use in patients where oral administration is not appropriate. This study evaluated safety after 1 and 4 weeks, and efficacy after 4 weeks' esomeprazole 40 mg once daily treatment, administered via an intravenous injection, intravenous infusion or orally, in patients with erosive esophagitis. METHODS: In this double-blind, multi-centre study, patients with endoscopically confirmed erosive esophagitis (Los Angeles grade A-D) were randomized to receive 1 week's treatment of esomeprazole 40 mg once daily, via a 3-min injection, a 30-min infusion or orally, followed by 3 weeks of open treatment with oral esomeprazole 40 mg once daily. Safety variables were evaluated following 1 and 4 weeks' esomeprazole treatment. Healing rates at 4 weeks were estimated. RESULTS: Intravenous and oral esomeprazole were equally well tolerated during the first week, and after 4 weeks' treatment. The 3 treatment groups showed similar levels of healing following 4 weeks' treatment with esomeprazole (injection + oral: 79.7%; infusion + oral: 80.2%; oral alone: 82.6%). CONCLUSIONS: Esomeprazole 40 mg administered via an intravenous injection, intravenous infusion or orally administered for 1 week, followed by 3 weeks of oral dosing, is well tolerated and provides effective healing of erosive esophagitis.     

Efficacy and safety of esomeprazole compared with omeprazole in GERD patients with erosive esophagitis: a randomized controlled trial

OBJECTIVE: In patients with gastroesophageal reflux disease (GERD), esomeprazole, the S-isomer of omeprazole, has demonstrated pharmacological and clinical benefits beyond those seen with the racemic parent compound. This study was designed to further evaluate the efficacy and tolerability of esomeprazole relative to that of omeprazole in healing erosive esophagitis and resolving accompanying symptoms of GERD. METHODS: Esomeprazole 40 mg was compared with omeprazole 20 mg once daily in 2425 patients with erosive esophagitis (Helicobacter pylori negative by serology) in an 8-wk, multicenter, randomized, double-blind, parallel-group study conducted in 163 centers throughout the US. The primary efficacy endpoint was the proportion of patients with healed esophagitis at wk 8. Secondary endpoints were the proportion of patients healed at wk 4, resolution of heartburn at wk 4, time to first resolution and sustained resolution of heartburn, and proportion of heartburn-free days and nights. Safety and tolerability were also assessed. RESULTS: Significantly more patients were healed with esomeprazole versus omeprazole at wk 8 (93.7% vs 84.2%, p < 0.001; life table estimates, intention-to-treat analysis). Healing rates at wk 4 were 81.7% and 68.7%, respectively. Esomeprazole was superior to omeprazole for all secondary measures and had a similar safety profile. The most common adverse events in both treatment groups were headache, diarrhea, and nausea. CONCLUSIONS: Esomeprazole demonstrates significantly greater efficacy than omeprazole in the treatment of GERD patients with erosive esophagitis. The tolerability and safety of esomeprazole are comparable to that of omeprazole. (Am     

Two doses of omeprazole versus placebo in symptomatic erosive esophagitis: the U.S. Multicenter Study.

Two hundred thirty patients with reflux symptoms and endoscopically proven erosive esophagitis were enrolled from 15 U.S. centers into a randomized, double-blind, dose-ranging study comparing placebo with omeprazole, 20 or 40 mg given once daily in the morning. Esophagitis grade 2 was present in 44% of patients, grade 3 in 37% of patients, and grade 4 in 19% of patients. Endpoints, defined as complete relief of heartburn and complete esophageal mucosal healing, were assessed after 4 and 8 weeks of treatment. Both omeprazole doses were significantly superior to placebo in complete endoscopic healing. After 8 weeks of treatment, 73.5% of patients in the 20-mg omeprazole group and 74.7% in the 40-mg omeprazole group, compared with 14.0% in the placebo group, had complete healing of the esophageal mucosa. At the end of the study, complete relief of daytime heartburn was obtained in 79.5% of patients in the 20-mg omeprazole group, 81.6% in the 40-mg omeprazole group, and 37.2% in the placebo group (P less than or equal to 0.05). Complete relief of nighttime heartburn was noted by 79.5% of patients in the 20-mg omeprazole group, 85.1% in the 40-mg omeprazole group, and 34.9% in the placebo group (P less than or equal to 0.05). The median time to complete relief of daytime and nighttime heartburn occurred earlier in the 40-mg group than in the 20-mg group (9 vs. 17 days and 9 vs. 20 days, respectively); however, these differences were not statistically significant. Relief of acid regurgitation and dysphagia also occurred earlier in the 40-mg group. Omeprazole was well tolerated in this group of patients. No unexpected adverse experiences occurred. The results of this study confirm those of six multicenter, international trials in which omeprazole in doses of 20-60 mg provided a degree of esophageal mucosal healing and complete relief of reflux symptoms superior to any other medical treatment.     

埃索美拉唑与奥美拉唑治疗老年反流性食管炎疗效比较

目的观察比较埃索美拉唑与奥美拉唑缓解老年人反流性食管炎的反流性症状、食管炎愈合的疗效及其安全性。方法80例经内镜证实的反流性食管炎患者,平均年龄74.26±6.64岁,随机分为两组,分别给予口服埃索美拉唑与奥美拉唑20mg,每日2次。治疗4周和8周时分别观察临床症状、内镜下食管炎愈合程度、24h食管pH动态监测以及不良反应。结果治疗4周时埃索美拉唑与奥美拉唑临床有效率分别为82.5%和77.5%(P<0.05),食管炎改善总有效率分别为82.5%和75.5%(P>0.05)。8周时埃索美拉唑临床有效率明显增加﹙97.5%vs.90.0%,P<0.01),内镜下食管炎愈合率及总有效率也明显高于奥美拉唑组(分别为87.5%vs.80.0%和97.5%vs.92.5%,P﹤0.05)。24h食管pH监测结果显示,两组治疗后pH﹤4的反流次数和时间百分比明显降低(P﹤0.001),以埃索美拉唑组下降幅度更为明显。两组均无严重不良反应事件发生。结论埃索美拉唑能有效缓解老年人反流性食管炎的反流症状,治愈或减轻内镜下食管炎程度,抑酸效果好,安全可靠。