Gillen Derek, Wirz Angela A, McColl Kenneth E L
GI Unit, Aberdeen Royal Infirmary, Scotland.
Gastroenterology. 2004 Apr;126(4):980-8. doi: 10.1053/j.gastro.2004.01.004.
BACKGROUND & AIMS: Rebound increased acid secretion has been observed at 2 weeks after discontinuing omeprazole treatment in Helicobacter pylori -negative, but not H. pylori -positive, subjects. It is unknown whether this is a prolonged phenomenon or whether a similar phenomenon appears later in H. pylori positives or is released by eradication therapy. The aims of this study were to answer these 3 questions.
Twelve H. pylori -negative and 20 H. pylori -positive subjects were studied. Each had a basal, submaximal, and maximal pentagastrin-stimulated acid secretion study before, during, and at 7, 14, 28, 42, and 56 days after a 56-day course of omeprazole 40 mg/day. Ten of the H. pylori -positive subjects had their infection eradicated during the last week of treatment.
In the H. pylori -negative subjects, there was rebound secretion of submaximal (P < 0.003) and maximal (P < 0.003) acid output, which persisted until at least 56 days after discontinuing omeprazole. The H. pylori -uneradicated subjects had no rebound increased secretion other than in maximal acid output at 28 (P < 0.01) and at 42 days after treatment (P < 0.02). In those eradicated of H. pylori close to the end of omeprazole, there was rebound increased secretion of submaximal acid output (P < 0.04) lasting until 56 days and of maximal acid output (P < 0.01) lasting until 28 days after treatment.
Rebound increased acid secretion following omeprazole is a prolonged phenomenon in H. pylori -negative subjects. There is little evidence of it in H. pylori -infected subjects, but eradicating the infection releases the phenomenon. The accentuated H. pylori -related oxyntic gastritis induced by omeprazole is likely to protect against the rebound phenomenon.
在幽门螺杆菌阴性而非阳性的受试者中，停用奥美拉唑治疗2周后观察到胃酸分泌反跳性增加。目前尚不清楚这是否是一种持续较长时间的现象，或者在幽门螺杆菌阳性受试者中是否会在更晚的时候出现类似现象，抑或是由根除治疗引发。本研究的目的是回答这三个问题。
对12名幽门螺杆菌阴性和20名幽门螺杆菌阳性受试者进行了研究。每位受试者在接受为期56天、每日40毫克奥美拉唑治疗前、治疗期间以及治疗后7天、14天、28天、42天和56天，分别进行了基础、次最大刺激和最大五肽胃泌素刺激胃酸分泌研究。20名幽门螺杆菌阳性受试者中有10名在治疗的最后一周根除了感染。
在幽门螺杆菌阴性受试者中，次最大（P < 0.003）和最大（P < 0.003）胃酸分泌量出现反跳，这种情况持续到停用奥美拉唑后至少56天。未根除幽门螺杆菌的受试者除了在治疗后28天（P < 0.01）和42天（P < 0.02）最大胃酸分泌量出现反跳外，没有其他分泌反跳增加的情况。在奥美拉唑治疗接近结束时根除幽门螺杆菌的受试者中，次最大胃酸分泌量反跳增加（P < 0.04）持续到治疗后56天，最大胃酸分泌量反跳增加（P < 0.01）持续到治疗后28天。
奥美拉唑治疗后胃酸分泌反跳性增加在幽门螺杆菌阴性受试者中是一种持续较长时间的现象。在幽门螺杆菌感染的受试者中几乎没有这种现象的证据，但根除感染会引发这种现象。奥美拉唑诱导的与幽门螺杆菌相关的胃体胃炎加重可能会预防反跳现象。
