Dajani E Z
International Drug Development Consultants (IDDC) Corporation, Long Grove, Illinois 60047-9532, USA.
J Assoc Acad Minor Phys. 2000;11(1):7-11.
Gastroesophageal reflux disease (GERD) is one of the most frequently encountered illnesses in the Western Hemisphere. GERD encompasses a spectrum of disorders in which reflux of gastric content into the esophagus causes symptoms and/or damage to the esophagus, oropharynx, or respiratory tract. This article provides a brief update on the pathophysiology and pharmacology of drugs used for the treatment of GERD. The etiology of GERD is multi-factorial and is believed to be principally a consequence of altered motility states in the esophagus and stomach. The drugs used for the treatment of GERD are continuously evolving, but as yet no drug has been shown to cure this chronic, relapsing disease. Antacids, prokinetics, and gastric antisecretory agents are the principal drugs currently used to treat GERD in conjunction with life-style modifications. Due to their ultrashort duration of buffering action, antacids are primarily used as self-medication for temporary relief of mild GERD symptoms. The prokinetic drug cisapride effectively resolves symptoms and heals mild-to-moderate esophagitis, with efficacy similar to that of the histamine H2-receptor antagonists. H2-receptor antagonists exhibit moderate inhibition of gastric acid secretion and are effective for resolving symptoms and healing mild-to-moderate esophagitis. In addition, H2-receptor antagonists slightly augment the therapeutic efficacy of cisapride for healing mild-to-moderate esophagitis. However, use of H2-receptor antagonists at higher doses and higher frequency approaches the efficacy of proton pump inhibitors in healing erosive esophagitis. Given their potent and long-lasting acid-reducing efficacy, proton pump inhibitors have become the drugs of choice for many patients with GERD. Despite progress in the medical treatment of GERD, there are still several unresolved questions relating to cost-effective strategies with specific drugs, how long pharmacologic therapy should be maintained, and when surgical intervention is warranted. Additional studies are clearly needed to address the unresolved treatment issues in GERD.
胃食管反流病（GERD）是西半球最常见的疾病之一。GERD包括一系列病症，其中胃内容物反流至食管会导致症状和/或对食管、口咽或呼吸道造成损害。本文简要介绍了用于治疗GERD的药物的病理生理学和药理学。GERD的病因是多因素的，主要被认为是食管和胃动力状态改变的结果。用于治疗GERD的药物在不断发展，但目前尚无药物被证明能治愈这种慢性复发性疾病。抗酸剂、促动力药和胃分泌抑制剂是目前与生活方式改变相结合用于治疗GERD的主要药物。由于其缓冲作用持续时间极短，抗酸剂主要用作自我用药以暂时缓解轻度GERD症状。促动力药西沙必利能有效缓解症状并治愈轻度至中度食管炎，其疗效与组胺H2受体拮抗剂相似。H2受体拮抗剂对胃酸分泌有中度抑制作用，对缓解症状和治愈轻度至中度食管炎有效。此外，H2受体拮抗剂可略微增强西沙必利治愈轻度至中度食管炎的治疗效果。然而，高剂量、高频使用H2受体拮抗剂在治愈糜烂性食管炎方面的疗效接近质子泵抑制剂。鉴于其强大而持久的抑酸效果，质子泵抑制剂已成为许多GERD患者的首选药物。尽管GERD的药物治疗取得了进展，但在特定药物的成本效益策略、药物治疗应维持多长时间以及何时需要手术干预等方面仍有几个未解决的问题。显然需要更多研究来解决GERD未解决的治疗问题。
