胃食管反流病患者雷贝拉唑52周维持治疗的多中心随访研究

背景：糜烂性食管炎（EE）和非糜烂性反流病（NERD）是胃食管反流病（GERD）两种常见的亚型，EE与NERD的关系仍存在争议。目的：探讨GERD患者雷贝拉唑52周维持治疗后2～3年随访时的反流症状、用药情况和内镜下表现变化。方法：2002年12月-2004年12月对67例EE患者和31例NERD患者行8周雷贝拉唑强化治疗和52周雷贝拉唑维持治疗，并于2～3年后随访上述患者。采用问卷调查了解患者的反流症状、用药情况，并复查内镜。结果：共随访到42例EE患者和21例NERD患者。EE患者和NERD患者所用的抑酸药类型和用药方式无明显差异。不同用药方式间患者的最严重反流症状总积分差异有统计学意义（P〈0．05），但最近2周反流症状总积分无明显差异。与治疗前比较，EE和NERD组反流症状积分均显著改善（P〈0．01）。EE组中23例（55．0％）患者食管糜烂复发，6例（31．5％）NERD患者转变为EE；GERD患者黏膜糜烂发生率与用药方式无关。结论：52周雷贝拉唑维持治疗后2。3年随访时，GERD的反流症状仍得到控制。但质子泵抑制剂维持治疗不能预防EE复发。EE和NERD两种亚型之间可互相转化。

52-week Rabeprazole Maintenance Treatment in Patients with Gastroesophageal Reflux Disease: A Multicentre Follow-up Study

Background： Erosive esophagitis （EE） and non-erosive reflux disease （NERD） are two common subtypes of gastroesophageal reflux disease （GERD）. Relationship between EE and NERD is still controversial. Aims： To investigate the changes of reflux symptoms, mode of medication and endoscopic findings in GERD patients at 2-3 years＇ followed-up after 52-week rabeprazole maintenance treatment. Methods： Sixty-seven patients with EE and 31 with NERD completed the 8-week rabeprazole intensification therapy and 52-week rabeprazole maintenance treatment from December 2002 to December 2004, and then were followed-up after 2-3 years. Reflux symptoms and mode of medication were assessed by questionnaire. Endoscopy was also performed. Results： Forty-two EE patients and 21 NERD patients were followed-up after 52-week rabeprazole maintenance treatment. No significant differences were found in types of acid inhibitory drug used and mode of medication between EE group and NERD group. Significant difference was shown in total score of the most severe reflux symptoms between groups with different mode of medication （P〈0.05）, but not in the total score of reflux symptoms in recent two weeks. The reflux symptom score in both EE and NERD groups after 2-3 years＇ follow-up were significantly decreased when compared with the pre-therapy baseline （P〈0.01）. Twenty-three patients （55.0%） in EE group had relapse of esophageal erosion. Meanwhile, 6 patients （31.5%） in NERD group changed into EE. No correlation was found between incidence of esophageal erosion and mode of medication. Conclusions： 52-week rabeprazole maintenance treatment is effective in improving the reflux symptoms of GERD after 2-3 years＇ follow-up. However, proton pump inhibitor maintenance treatment could not prevent the relapse of EE. Mutual conversion may occur between EE and NERD.