Ortiz A, Martínez de Haro L F, Parrilla P, Molina J, Bermejo J, Munitiz V
Department of Surgery, University Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain.
Br J Surg. 1999 Nov;86(11):1472-4. doi: 10.1046/j.1365-2168.1999.01273.x.
Control of acid reflux is the main objective of treatment for Barrett's oesophagus. However, as these patients have a reduced sensitivity to acid reflux, disappearance of symptoms may not correlate with efficient control of acid reflux. The aim of this study was to determine in a group of patients with Barrett's oesophagus whether treatment with proton pump inhibitors suppressed pathological acid reflux once the symptoms of reflux had been controlled and the associated inflammatory lesions cured.
Eighteen consecutive patients with Barrett's oesophagus were studied, all of whom presented with heartburn. Twenty-four-hour oesophageal pH monitoring before treatment showed pathological acid reflux in all cases: median percentage of total time with pH less than 4, 22 (range 8-52) per cent. All patients received proton pump inhibitors (dose 20-60 mg/day) until symptoms were controlled.
While on therapy, pH was reduced (median percentage of total time with pH less than 4, 3 versus 22 per cent; P < 0.001). However, three patients had persistent pathological rates of acid reflux.
Disappearance of symptoms is not a good indicator of control of pathological acid reflux in patients with Barrett's oesophagus. Twenty-four-hour pH monitoring should be performed for proper adjustment of the dose of medication.
控制胃酸反流是巴雷特食管治疗的主要目标。然而，由于这些患者对胃酸反流的敏感性降低，症状消失可能与胃酸反流的有效控制不相关。本研究的目的是在一组巴雷特食管患者中确定，在反流症状得到控制且相关炎症病变治愈后，质子泵抑制剂治疗是否能抑制病理性胃酸反流。
对连续18例巴雷特食管患者进行研究，所有患者均有烧心症状。治疗前24小时食管pH监测显示所有病例均存在病理性胃酸反流：pH值小于4的总时间中位数百分比为22%（范围8 - 52%）。所有患者均接受质子泵抑制剂治疗（剂量20 - 60毫克/天），直至症状得到控制。
在治疗期间，pH值降低（pH值小于4的总时间中位数百分比，从22%降至3%；P < 0.001）。然而，有3例患者胃酸反流的病理性发生率持续存在。
症状消失并非巴雷特食管患者病理性胃酸反流得到控制的良好指标。应进行24小时pH监测以适当调整药物剂量。
