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。     

Control of intra-oesophageal and intra-gastric pH with proton pump inhibitors in patients with Barrett''s oesophagus

BACKGROUND: A significant percentage of patients with Barrett's oesophagus (BE) will continue to manifest abnormal intra-oesophageal pH profiles regardless of proton pump inhibitor (PPI) therapy. AIMS: We conducted a prospective study in order to determine whether a change in PPI therapy would alter intra-oesophageal and intra-gastric acid suppression in BE patients. PATIENTS: Seventeen Helicobacter pylori-negative BE patients (16 males, 1 female; mean+/-S.D. age, 63.5+/-13.2). METHODS: Twenty-four-hour pH monitoring was performed on omeprazole or lansoprazole, followed by repeat pH monitoring on rabeprazole at a dose titrated for symptom relief. Patients completed validated symptom and health-related quality-of-life (HRQL) surveys while on and off therapy. RESULTS: Ten (59%) of the 17 patients had abnormal baseline intra-oesophageal pH profiles. Oesophageal pH monitoring values on rabeprazole were abnormal in five out of five (100%) of the omeprazole cohort and three out of five (60%) of the lansoprazole cohort that had abnormal pH profiles on initial testing. Intra-gastric pH control was inadequate in BE patients on all PPIs; the mean percentage time with intra-gastric pH below 4.0 was 46% on omeprazole, 71% on lansoprazole and 51% on rabeprazole (p=0.25). All of the patients demonstrated the phenomenon of nocturnal acid breakthrough while undergoing PPI therapy. CONCLUSIONS: Change in PPI therapy did not alter intra-oesophageal or intra-gastric control in patients with BE.     

Efficacy of mosapride plus proton pump inhibitors for treatment of gastroesophageal reflux disease: A systematic review

AIM:To assess the potential benefits of mosapride plus proton pump inhibitors(PPIs)in the treatment of gastroesophageal reflux disease.METHODS:A literature search was performed through MEDLINE,EMBASE,and the ISI Web of Knowledge.The clinical trials that compared the benefit of mosapride plus PPI treatment with that of PPI monotherapy were analyzed.The rate of responders was evaluated by the pooled relative risk(PRR)and improvement in symptom scores was assessed by single effect size of a standardized mean,while Hedges’g was used as the effect size.Pooled effect sizes with 95%CIs were calculated using a fixed-effects model.Between-study heterogeneity was assessed using Q test and I2analyses.In addition,studies that assessed the additional efficacy of mosapride in PPI-resistant patients were also reviewed.RESULTS:This systematic review included information on a total of 587 patients based on 7 trials.Four trials compared the efficacy of combination therapy of mosapride plus a PPI with that of PPI monotherapy.The statistical analysis for the effect of additional mosapride showed equivocal results(PRR=1.132;95%CI:0.934-1.372;P=0.205;Hedges’g=0.24;95%CI:0.03-0.46;P=0.023).No heterogeneity and publication bias were found among the studies.Three openlabeled trials assessed the additional efficacy of mosapride in PPI-resistant patients.However,since these trials did not set the control group,the results may be considerably biased.CONCLUSION:Mosapride combined therapy is not more effective than PPI alone as first-line therapy.Whether it is effective in PPI-resistant patients needs to be determined.     

心理因素对质子泵抑制剂维持治疗老年非糜烂性反流病患者生活质量的影响

目的 探讨心理因素对质子泵抑制剂维持治疗的老年非糜烂性反流病(NERD)患者生活质量的影响. 方法 选择我院已确诊且用质子泵抑制剂(埃索美拉唑)维持治疗半年以上老年NERD患者76例,根据临床症状,参照反流性疾病问卷,将76例患者分为有症状组和无症状组,分别对两组患者进行Zung焦虑自评量表(SAS)和Zung抑郁自评量表(SDS)评分.并同时用胃食管反流病相关生活质量量表(GERD HRQL)和SF 36健康量表评估患者生活质量. 结果 与无症状组及健康对照组比较,有症状组SAS、SDS 评分明显升高(P＜0.05),GERD-HRQL评分增高(x2=19.689,P＜0.01),SF-36除生理功能外的其他7个健康维度评分明显降低(P＜0.05).相关分析发现,有症状组SAS、SDS得分与GERD-HRQL评分呈正相关(P＜0.01),与SF-36除生理功能外的其他7个健康维度评分呈负相关(P＜0.05). 结论 质子泵抑制剂疗效差的老年NERD患者,多数合并心理问题,生活质量明显下降;老年NERD患者心理异常与生活质量下降明显相关.     

Long-term treatment with proton pump inhibitor is associated with undesired weight gain

AIM： To examine the effects of long-term proton pump inhibitor （PPI） therapy on body weight （BW） and body mass index （BMI） in patients with gastroesophageal reflux disease （GERD）. METHODS： The subjects were 52 patients with GERD and 58 sex- and age-matched healthy controls. GERD patients were treated with PPI for a mean of 2.2 years （range, 0.8-5.7 years）, and also advised on lifestyle modifications （e.g. selective diet, weight management）. BW, BMI and other parameters were measured at baseline and end of study. RESULTS： Twenty-four GERD patients were treated daily with 10 mg omeprazole, 12 with 20 mg omeprazole, 8 with 10 mg rabeprazole, 5 with 15 mg lansoprazole, and 3 patients with 30 mg lansoprazole. At baseline, there were no differences in BW and BMI between reflux patients and controls. Patients with GERD showed increases in BW （baseline： 56.4 ± 10.4 kg, end： 58.6 ± 10.8 kg, mean ± SD, P 〈 0.0001） and BMI （baseline： 23.1 ± 3.1 kg/m^2, end： 24.0 ± 3.1 kg/m^2, P 〈 0.001）, but no such changes were noted in the control group. Mean BW increased by 3.5 kg （6.2% of baseline） in 37 （71%） reflux patients but decreased in only 6 （12%） patients during treatment. CONCLUSION： Long-term PPI treatment was associatedwith BW gain in patients with GERD. Reflux patients receiving PPI should be encouraged to manage BW through lifestyle modifications.     

Risk factors for proton pump inhibitor refractoriness in Chinese patients with non-erosive reflux disease

AIM:To analyze risk factors for refractoriness to proton pump inhibitors(PPIs) in patients with non-erosive reflux disease(NERD).METHODS:A total of 256 NERD patients treated with the PPI esomeprazole were enrolled.They were classified into symptom-free and residual symptoms groups according to Quality of Life in Reflux and Dyspepsia(QolRad) scale.All subjects completed questionnaires on psychological status(self-rating anxiety scale;selfrating depression scale) and quality of life scale(Short Form 36).Multivariate analysis was used to determine the predictive factors for PPI responses.RESULTS:According to QolRad,97 patients were confirmed to have residual reflux symptoms,and the remaining 159 patients were considered symptom free.There were no significant differences between the two groups in lifestyle factors(smoking and alcohol consumption),age,Helicobacter pylori infection,and hiatal hernia.There were significant differences between the two groups in relation to sex,psychological distress including anxiety and depression,body mass index(BMI),and irritable bowel syndrome(IBS)(P < 0.05).Logistic regression analysis found that BMI < 23,comorbid IBS,anxiety,and depression were major risk factors for PPI resistance.Symptomatic patients had a lower quality of life compared with symptom-free patients.CONCLUSION:Some NERD patients are refractory to PPIs and have lower quality of life.Residual symptoms are associated with psychological distress,intestinal disorders,and low BMI.     

Efficacy of endoluminal gastroplication in Japanese patients with proton pump inhibitor-resistant, non-erosive esophagitis

AIM:To evaluate the efficacy,safety,and long-term outcomes of endoluminal gastroplication(ELGP) in patients with proton pump inhibitor(PPI)-resistant,nonerosive reflux disease(NERD).METHODS:The subjects were NERD patients,diagnosed by upper endoscopy before PPI use,who had symptoms such as heartburn or reflux sensations two or more times a week even after 8 wk of full-dose PPI treatment.Prior to ELGP,while continuing full-dose PPI medication,patients' symptoms and quality of life(QOL) were assessed using the questionnaire for the diagnosis of reflux disease,the frequency scale for symptoms of gastro-esophageal reflux disease(FSSG),gastrointestinal symptoms rating scale,a 36-item short-form.In addition,24-h esophageal pH monitoring or 24-h intraesophageal pH/impedance(MII-pH) monitoring was performed.The Bard EndoCinch TM was used for ELGP,and 2 or 3 plications were made.After ELGP,all acid reducers were temporarily discontinued,and medication was resumed depending on the development and severity of symptoms.Three mo after ELGP,symptoms,QOL,pH or MII-pH monitoring,number of plications,and PPI medication were evaluated.Further,symptoms,number of plications,and PPI medication were evaluated 12 mo after ELGP to investigate long-term effects.RESULTS:The mean FSSG score decreased significantly from before ELGP to 3 and 12 mo after ELGP(19.1 ± 10.5 to 10.3 ± 7.4 and 9.3 ± 9.9,P 0.05,respectively).The total number of plications decreased gradually at 3 and 12 mo after ELGP(2.4 ± 0.8 to 1.2 ± 0.8 and 0.8 ± 1.0,P 0.05,respectively).The FSSG scores in cases with no remaining plications and in cases with one or more remaining plications were 4.4 and 2.7,respectively,after 3 mo,and 2.0 and 2.8,respectively,after 12 mo,showing no correlation to plication loss.On pH monitoring,there was no difference in the percent time pH 4 from before ELGP to 3 mo after.Impedance monitoring revealed no changes in the number of reflux episodes or the symptom index for reflux events from before ELGP to 3 mo after,but the symptom sensitivity index decreased significantly 3 mo after ELGP(16.1 ± 12.9 to 3.9 ± 8.3,P 0.01).At 3 mo after ELGP,6 patients(31.6%) had reduced their PPI medication by 50% or more,and 11 patients(57.9%) were able to discontinue PPI medication altogether.After 12 mo,3 patients(16.7%) were able to reduce the amount of PPI medication by 50% or more,and 12 patients(66.7%) were able to discontinue PPI medication altogether.A high percentage of cases with remaining plications had discontinued PPIs medication after 3 mo,but there was no difference after 12 mo.No serious complications were observed in this study.CONCLUSION:ELGP was safe,resulted in significant improvement in subjective symptoms,and allowed less medication to be used over the long term in patients with PPI-refractory NERD.     

Comparison of four proton pump inhibitors for the short-term treatment of esophagitis in elderly patients

AIM: To compare efficacy and tolerability of four proton pump inhibitors (PPIs) commonly used in the short-term therapy of esophagitis in elderly patients.METHODS: A total of 320 patients over 65 years with endoscopically diagnosed esophagitis were randomly assigned to one of the following treatments for 8 wk: (1) omeprazole 20 mg/d; (2) lansoprazole 30 mg/d; (3) pantoprazole 40 mg/d, or (4) rabeprazole 20 mg/d. Major symptoms, compliance, and adverse events were recorded. After 8 wk, endoscopy and clinical evaluation were repeated.RESULTS: Per protocol and intention to treat healing rates of esophagitis were: omeprazole = 81.0% and 75.0%, lansoprazole = 90.7% (P = 0.143 vs omeprazole) and 85.0%, pantoprazole = 93.5% (P = 0.04 vs omeprazole) and 90.0% (P = 0.02 vs omeprazole), rabeprazole = 94.6% (P = 0.02 vs omeprazole) and 88.8% (P = 0.04 vs omeprazole). Dividing patients according to the grades of esophagitis, omeprazole was significantly less effective than the three other PPIs in healing grade 1 esophagitis (healing rates: 81.8% vs 100%, 100% and 100%, respectively, P = 0.012). Pantoprazole and rabeprazole (100%) were more effective vs omeprazole (89.6%, P = 0.0001)and lansoprazole (82.4%, P = 0.0001) in decreasing heartburn. Pantoprazole and rabeprazole (92.2% and 90.1%, respectively) were also more effective vs lansoprazole (75.0%, P < 0.05) in decreasing acid regurgitation. Finally, pantoprazole and rabeprazole (95.2% and 100%) were also more effective vs lansoprazole (82.6%, P < 0.05) in decreasing epigastric pain.CONCLUSION: In elderly patients, pantoprazole and rabeprazole were significantly more effective than omeprazole in healing esophagitis and than omeprazole or lansoprazole in improving symptoms. H pylori infection did not influence the healing rates of esophagitis after a short-term treatment with PPI.     

Systematic review:Laparoscopic fundoplication for gastroesophageal reflux disease in partial responders to proton pump inhibitors

AIM:To assess laparoscopic fundoplication(LF)in partial responders to proton pump inhibitors(PPIs)for gastroesophageal reflux disease(GERD).METHODS:We systematically searched PubMed and Embase(1966-Dec 2011)for articles reporting data on LF efficacy in partial responders.Due to a lack of randomized controlled trials,observational studies were included.Of 558 articles screened,17 were eligible for inclusion.Prevalence data for individual symptoms were collated across studies according to mutually compatible time points(before and/or after LF).Where suitable,prevalence data were presented as percentage of patients reporting symptoms of any frequency or severity.RESULTS:Due to a lack of standardized reporting of symptoms,the proportion of patients experiencing symptoms was recorded across studies where possible.After LF,the proportion of partial responders with heartburn was reduced from 93.1%(5 studies)to 3.8%(5 studies),with similar results observed for regurgitation[from 78.4%(4 studies)to 1.9%(4 studies)].However,10 years after LF,35.8%(2 studies)of partial responders reported heartburn and 29.1%(1 study)reported regurgitation.The proportion using acidsuppressive medication also increased,from 8.8%(4studies)in the year after LF to 18.2%(2 studies)at 10years.In the only study comparing partial responders to PPI therapy with complete responders,higher symptom scores and more frequent acid-suppressive medication use were seen in partial responders after LF.CONCLUSION:GERD symptoms improve after LF,but subsequently recur,and acid-suppressive medication use increases.LF may be less effective in partial responders than in complete responders.     

Effect of electrical stimulation of the lower esophageal sphincter in gastroesophageal reflux disease patients refractory to proton pump inhibitors

AIM: To evaluate the efficacy of lower esophageal sphincter(LES)-electrical stimulation therapy(EST) in a subgroup of patients that reported only partial response to proton pump inhibitors(PPIs) therapy, compared to a group of patient with complete response.METHODS: Bipolar stitch electrodes were laparoscopically placed in the LES and connected to an implantable pulse generator(EndoS tim BV, the Hague, the Netherlands), placed subcutaneously in the anterior abdominal wall. Stimulation at 20 Hz, 215 μsec, 3-8 m Amp in 30 min sessions was delivered starting on day 1 post-implant. Patients were evaluated using gastroesophageal reflux disease(GERD)-HRQL, symptom diaries; esophageal p H and esophageal manometry before and up to 24 mo after therapy and results were compared between partial and complete responders.RESULTS: Twenty-three patients with GERD on LESEST were enrolled and received continuous per-protocol stimulation through 12 mo and 21 patients completed 24 mo of therapy. Of the 23 patients, 16(8 male, mean age 52.1 ± 12 years) had incomplete response to PPIs prior to LES-EST, while 7 patients(5 male, mean age 52.7 ± 4.7) had complete response to PPIs. In the sub-group with incomplete response to PPIs, median(IQR) composite GERD-HRQL score improved significantly from 9.5(9.0-10.0) at baseline on-PPI and 24.0(20.8-26.3) at baseline off-PPI to 2.5(0.0-4.0) at 12-mo and 0.0(0.0-2.5) at 24-mo follow-up(P 0.05 compared to on-and off-PPI at baseline). Median(IQR) % 24-h esophageal pH 4.0 at baseline in this sub-group improved significantly from 9.8%(7.8-11.5) at baseline to 3.0%(1.9-6.3) at 12 mo(P 0.001) and 4.6%(2.0-5.8) at 24 mo follow-up(P 0.01). At their 24-mo follow-up, 9/11 patients in this sub-group were completely free of PPI use. These results were comparable to the sub-group that reported complete response to PPI therapy at baseline. No unanticipated implantation or stimulation-related adverse events, or any untoward sensation due to stimulation were reported in either group and LES-EST was safely tolerated by both groups. CONCLUSION: LES-EST is safe and effective in controlling symptoms and esophageal acid exposure in GERD patients with incomplete response to PPIs. These results were comparable to those observed PPI responders.     

Combined multichannel intraluminal impedance and pH monitoring is helpful in managing children with suspected gastro-oesophageal reflux disease

BackgroundGastro-oesophageal reflux is very common in the paediatric age group. There is no single and reliable test to distinguish between physiologic and pathological gastro-oesophageal reflux, and this lack of clear distinction between disease and normal can have a negative impact on the management of children.AimsTo evaluate the usefulness of 24-h oesophageal pH-impedance study in infants and children with suspected gastro-oesophageal reflux disease.MethodsPatients were classified by age groups (A–C) and reflux-related symptoms (typical and atypical). All underwent pH-impedance study. If the latter suggested an abnormal reflux, patients received therapy in accordance with NASPGHAN/ESPGHAN recommendations, while those with normal study had an additional diagnostic work-up. The efficacy of therapy was evaluated with a specific standardized questionnaire for different ages.ResultsThe study was abnormal in 203/428 patients (47%) while normal in 225/428 (53%). Of those with abnormal study, 109 exhibited typical symptoms (54%), and 94 atypical (46%). The great majority of the patients with abnormal study were responsive to medical anti-reflux therapy.ConclusionsWe confirm the utility of prolonged oesophageal pH-impedance study in detecting gastro-oesophageal reflux disease in children and in guiding therapy. Performing oesophageal pH-impedance monitoring in children with suspected gastro-oesophageal reflux disease is helpful to establish the diagnosis and avoid unnecessary therapy.     

Oesophageal acid-peptic strictures in the histamine H2 receptor antagonist and proton pump inhibitor era

BACKGROUND AND AIM: We present a survey on the incidence, demography and natural history (re-dilatation rates) of patients with oesophageal acid-peptic stricture seen between 1977 and 1995. PATIENTS AND METHODS: Prospective, cohort observational study. Stricture severity was graded mild, moderate or severe (needing forcible dilatation with bougies). Most were treated with histamine H2 receptor antagonists or proton pump inhibitors, and were followed up by serial check endoscopy. RESULTS: A total of 156 of 7429 (2%) reflux patients had stricture: mild, n=56; moderate, n=25; severe, n=75. The prevalence of reflux disease is rising, paralleled by an increase in the number of patients with stricture; hence the incidence of stricture is unchanged: 1977-1982, 1.8% (18/986); 1983-1989, 2.4% (61/2595); 1990-1995, 2% (77/3848). Demography: mean age 68 years; mean length of reflux history 6.4 years; 15% on non-steroidal anti-inflammatory drugs/aspirin; 18% with Barrett's metaplasia. Mean follow-up: 5.6 years. Outcome: of the 75 with severe stricture, 36 (48%) needed forcible dilatation only once, and 39 more often (13 twice, nine three times), most within 2 years. Only six of these patients need > or = 6 re-dilatations. CONCLUSION: The incidence of stricture is low and remains unchanged, despite the increased prevalence of reflux disease. Most patients have a good prognosis, only half needing further forcible dilatation, mainly within the first 2 years.     

Rebuilding trust in proton pump inhibitor therapy

Introduction of proton pump inhibitor (PPI) therapy into clinical practice has revolutionized treatment approach to acid-related diseases. With its clinical success came a widespread use of PPI therapy. Subsequently, several studies found that PPIs were oftentimes overprescribed in primary care and emergency setting, likely attributed to seemingly low side-effect profile and physicians having low threshold to initiate therapy. However, now there is a growing concern over PPI side-effect profile among both patients and providers. We would like to bring more awareness to the currently available guidelines on PPI use, discuss clinical indications for PPIs and the evidence behind the reported side-effects. We hope that increased awareness of proper PPI use will make the initiation or continuation of therapy a well informed and an evidence-based decision between patient and physician. We also hope that discussing evidence behind the reported side-effect profile will help clarify the growing concerns over PPI therapy.     

质子泵抑制剂在经皮冠状动脉介入治疗术后抗血小板治疗中的价值

目的 探讨质子泵抑制剂（proton pump inhibitor,PPI）对经皮冠状动脉介入治疗术（PCI）后抗血小板治疗中上消化道出血及不良心血管事件（MACCE）发生的影响.方法 选择在襄阳市中心医院心血管内科行PCI术的患者364例,术前、术后均给予氯吡格雷联合阿司匹林抗血小板治疗,随机分为3组：奥美拉唑组（n=121）、埃索美拉唑组（n=133）、对照组（n=110）.随访12个月,观察各组患者上消化道出血和MACCE的发生率.结果 奥美拉唑组、埃索美拉唑组、对照组上消化道出血发生率分别为2.48%、1.50%、10.91%,MACCE发生率分别为：9.09%、8.27%、8.18%.对照组的上消化道出血发生率显著高于奥美拉唑组和埃索美拉唑组,差异有统计学意义（P〈0.01）,而奥美拉唑组和埃索美拉唑组间的上消化道出血发生率差异无统计学意义（P〉0.05）.3组间的MACCE发生率差异无统计学意义（P〉0.05）.结论奥美拉唑与埃索美拉唑可预防对PCI后抗血小板治疗患者上消化道出血的发生,二者均不增加MACCE的发生率.     

质子泵和质子泵抑制剂研究进展

胃壁细胞H^ ,K^＋－ATP酶是一种质子泵，能特异性地将H^ 泵入胃腔，形成胃内高酸状态。质子泵抑制剂（PPI）为苯丙咪唑替代物，在体内转化为活性物质－－次磺酰胺，后者与H^ ,K^ －ATP酶共价结合，从而抑制该酶活性，抑制胃酸分泌，是治疗各种酸相关性疾病的首选药物。旧一代PPI如奥美拉唑，兰索拉唑和泮托拉唑的药代动力学个体差异大，与其他药物作用明显，起效时间慢，而新一代PPI如雷贝拉唑、伊索美拉唑起效快，抑酸效果更好，尤其在治疗胃食管反流性疾病（GERD）方面疗效更佳。     

On-demand proton pump inhibitor therapy in patients with gastro-oesophageal reflux disease

On-demand therapy is an established modality in long-term therapy with histamine-2-receptor antagonists, in cases of mild non-erosive gastro-oesophageal reflux disease. In the literature, only a few studies have specifically addressed the problem of proton pump inhibitors on-demand treatment. The evidence, so far, available suggests that this might be an effective modality of long-term treatment in the majority of patients with non-erosive gastro-oesophageal reflux disease. This treatment modality appears to be the most cost-effective and the best tolerated medical regimen for gastro-oesophageal reflux disease. It also seems to be able to restore the impairment of health-related quality of life due to gastro-oesophageal reflux disease symptoms. Although the current standard of care for patients with non-erosive gastro-oesophageal reflux disease is maintenance therapy with daily administration of a proton pump inhibitor agent, on-demand therapy, with the same drug, may be a reasonable long-term choice. The ideal proton pump inhibitors for such treatment will be those with a more rapid onset of action, more profound acid inhibition, more predictable therapeutic effect and less drug-drug interactions. Newer proton pump inhibitors, like esomeprazole, the S-chiral isomer of omeprazole, are promising drugs for on-demand treatment of gastro-oesophageal reflux disease.     

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．