适度抑酸与小儿消化性溃疡愈合关系的研究

目的 了解胃酸抑制与小儿消化性溃疡愈合的关系,寻求最适抑酸度。方法 将消化性溃疡患儿２７例随机分成两组,分别用雷尼替丁（Ａ组）和奥美拉唑（Ｂ组）口服治疗４￣６周（平均５周）,监测治疗前和给药第１天、第１及５周时的胃ｐＨ变化,并复查胃镜,评价溃疡愈合情况。结果 Ａ组１６例中６例未愈合,１０例愈合,Ｂ组１１例全部愈合。抗酸治疗后两组患儿胃ｐＨ值均升高,Ａ组胃ｐＨ平均值,ｐＨ平均中位数及ｐＨ〉３时间百分

Optimalsuppression of gastric acid and ulcer healing in children with peptic ulcer

Objective It is well known that the suppression of gastric acidity is one of the most essential factors in promoting healing and preventing relapse of peptic ulcers. Little is known, however, about how to inhibit gastric acid secretion effectively in children with peptic ulcers. The present study aimed at understanding the optimal acid suppression by examining the relationship between ulcer healing and the suppression of gastric acid in children. Methods Patients with peptic ulcers diagnosed by endoscopy were randomized to receive either oral ranitidine (group A) or oral omeprazole (group B) for 4 6 weeks (mean 5 weeks). Intragastric 24 hour pH monitoring was performed before treatment, and repeated three times: on day 1, weeks 1 and 5 post dosing. Endoscopy was repeated on week 5 to evaluate the healing condition of ulcers. Results Twenty seven patients followed up by endoscopy and pH monitoring were eligible for final analysis. The ulcers in 16 patients of group A and in all (11 cases) of group B were healed. No significant differences in the gastric mean pH, median pH and percentage of time with gastric pH>3 between the two groups were observed before treatment. Gastric pH increased significantly after treatment in both groups. These parameters in group A decreased significantly during weeks 1 and 5 as compared to those on day 1 post dosing; the duration of drug action was also shortened significantly. The gastric mean pH and mean median pH in group B were significantly higher during weeks 1 and 5 than on day 1 of post dosing, the duration of drug action was also prolonged significantly. According to the result of endoscopic re examination, the authors subdivided group A into unhealed (group C) and healed (group D) groups. The gastric acid suppressive effect in group C attenuated significantly by the end of the 5 week treatment and the differences of gastric mean pH and median pH, percentage of time with pH>3 between week 5 and pre treatment level were not significant. While these parameters in group D were still significantly higher during week 5 than those obtained before treatment. The gastric mean pH and median pH, percentage of time with pH>3 and the duration of drug action during week 5 were significantly higher in group D than in group C. The mean shortest duration of drug action in group B was 10 h, while it was 5 h in group D. Conclusions The onset of tolerance to ranitidine during the therapy might have affected healing of ulcers in the subjects. The optimal acid suppression for healing ulcers in children could be regarded as maintaining the gastric pH>3 for 5 10 hours a day of post dosing during 4 6 weeks of anti secretory treatment.