Vela M F, Tutuian R, Katz P O, Castell D O
Department of Medicine, Graduate Hospital, Philadelphia, PA, USA.
Aliment Pharmacol Ther. 2003 Jan;17(2):243-51. doi: 10.1046/j.1365-2036.2003.01394.x.
Omeprazole controls acid but not non-acid reflux. The GABA B agonist baclofen decreases acid reflux through the inhibition of transient lower oesophageal sphincter relaxations (TLESRs) and should similarly decrease non-acid reflux. Using combined multichannel intraluminal impedance and pH (MII/pH), we compared acid and non-acid reflux after placebo and baclofen.
Nine healthy volunteers and nine heartburn patients underwent two 2-h studies of combined MII/pH in right lateral decubitus after a refluxogenic meal in random order: on placebo and after baclofen 40 mg p.o. Tracings were analysed for acid and non-acid reflux episodes, re-reflux and symptoms in the heartburn patients.
In normal subjects baclofen significantly reduced the median number of episodes of acid (7 vs. 1, P = 0.02), non-acid (2 vs. 0, P = 0.005), and all reflux combined (10 vs. 2, P = 0.006); re-reflux was not reduced (0 vs. 0, P = N.S.). In heartburn patients, baclofen significantly decreased the median number of episodes of acid (15 vs. 6, P = 0.004), non-acid (4 vs. 2, P = 0.003), re-reflux (2 vs. 0, P = 0.02), and all reflux combined (23 vs. 8, P = 0.004); it also reduced the median number of acid-related (9 vs. 1, P = 0.008) and non-acid-related (1 vs. 0, P = 0.04) symptoms.
Baclofen reduces post-prandial acid and non-acid reflux and their associated symptoms. GABA B agonists may have a role in treating GERD.
奥美拉唑可控制胃酸反流，但对非胃酸反流无效。γ-氨基丁酸B（GABA B）激动剂巴氯芬可通过抑制食管下括约肌一过性松弛（TLESRs）来减少胃酸反流，同理也应能减少非胃酸反流。我们运用联合多通道腔内阻抗-pH监测技术（MII/pH），比较了安慰剂和巴氯芬治疗后的胃酸反流和非胃酸反流情况。
9名健康志愿者和9名胃灼热患者在摄入致反流餐后，以随机顺序接受了两次右侧卧位2小时的联合MII/pH监测研究：一次服用安慰剂，另一次口服40毫克巴氯芬后进行监测。分析胃灼热患者的胃酸反流和非胃酸反流发作次数、再反流情况及症状。
在正常受试者中，巴氯芬显著减少了胃酸反流发作的中位数（7次对1次，P = 0.02）、非胃酸反流发作的中位数（2次对0次，P = 0.005）以及所有反流发作的中位数（10次对2次，P = 0.006）；再反流情况未减少（0次对0次，P = 无显著差异）。在胃灼热患者中，巴氯芬显著减少了胃酸反流发作的中位数（15次对6次，P = 0.004）、非胃酸反流发作的中位数（4次对2次，P = 0.003）、再反流发作的中位数（2次对0次，P = 0.02）以及所有反流发作的中位数（23次对8次，P = 0.004）；还减少了与胃酸相关症状的中位数（9次对1次，P = 0.008）和与非胃酸相关症状的中位数（1次对0次，P = 0.04）。
巴氯芬可减少餐后胃酸反流和非胃酸反流及其相关症状。GABA B激动剂可能在治疗胃食管反流病（GERD）中发挥作用。
