Ozawa Tatsuo, Yoshikawa Nozomi, Tomita Takashige, Akita Yasushi, Mitamura Keiji
Second Department of Internal Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan.
J Gastroenterol. 2003;38(9):844-8. doi: 10.1007/s00535-003-1159-y.
This study investigated the influence of feeding on gastric acid suppression in Helicobacter pylori-positive patients treated with intravenous infusions of proton pump inhibitors (PPIs) or with H2-receptor antagonists (H2-RAs) after bleeding from a gastric ulcer.
Forty-nine H. pylori-positive patients with bleeding gastric ulcers (44 men and 5 women) were divided into four groups: one group received an H2-RA while fasting, one group received an H2-RA while eating regularly, one group received a PPI while fasting, and one group received a PPI while eating regularly. Intragastric pH was monitored during fasting and nonfasting to calculate the pH 3 and pH 4 holding times and the mean pH.
During a 24-h fast, the pH 3 and pH 4 holding times and the mean pH were significantly higher in patients administered omeprazole (PPI; 93.2 +/- 9.2%, 90.6 +/- 11.1%, and 6.9 +/- 0.6, respectively) than in those administered ranitidine (H2-RA; 61.0 +/- 27.5%, 55.8 +/- 29.1%, and 4.8 +/- 1.3, respectively; P<0.001 for all). Results were similar during feeding (PPI meal, 98.9 +/- 2.6%, 98.3 +/- 3.7%, and 6.9 +/- 0.3; H2-RA meal, 59.8 +/- 17.6%, 49.7 +/- 18.0%, and 4.3 +/- 0.7, respectively; P<0.001 for all). In addition, the pH 3 and pH 4 holding times and the mean pH in the H2-RA meal group were not significantly lower than those in the H2-RA group (P=0.999, P=0.865, and P=0.687, respectively). The values in the PPI and PPI meal groups were similar (P=0.872, P=0.777, and P>0.999, respectively).
Gastric acid suppression during the administration of an H2-RA or a PPI soon after the cessation of gastric bleeding was scarcely affected by feeding. It may well be that H. pylori-positive patients with bleeding gastric ulcer can resume a regular diet and return to work soon after bleeding ceases.
本研究调查了进食对幽门螺杆菌阳性患者胃酸抑制的影响，这些患者在胃溃疡出血后接受静脉输注质子泵抑制剂（PPI）或H2受体拮抗剂（H2-RA）治疗。
49例幽门螺杆菌阳性的胃溃疡出血患者（44例男性和5例女性）被分为四组：一组在禁食时接受H2-RA，一组在正常进食时接受H2-RA，一组在禁食时接受PPI，一组在正常进食时接受PPI。在禁食和非禁食期间监测胃内pH值，以计算pH 3和pH 4保持时间以及平均pH值。
在24小时禁食期间，接受奥美拉唑（PPI）治疗的患者的pH 3和pH 4保持时间以及平均pH值（分别为93.2±9.2%、90.6±11.1%和6.9±0.6）显著高于接受雷尼替丁（H2-RA）治疗的患者（分别为61.0±27.5%、55.8±29.1%和4.8±1.3；所有P<0.001）。进食期间结果相似（PPI餐，98.9±2.6%、98.3±3.7%和6.9±0.3；H2-RA餐，分别为59.8±17.6%、49.7±18.0%和4.3±0.7；所有P<0.001）。此外，H2-RA餐组的pH 3和pH 4保持时间以及平均pH值并不显著低于H2-RA组（分别为P=0.999、P=0.865和P=0.687）。PPI组和PPI餐组的值相似（分别为P=0.872、P=0.777和P>0.999）。
胃出血停止后不久给予H2-RA或PPI期间的胃酸抑制几乎不受进食影响。很可能幽门螺杆菌阳性的胃溃疡出血患者在出血停止后可以很快恢复正常饮食并重返工作岗位。
