Louis E, Jorissen P, Bastens B, D'Haens G, Schoofs N, Burette A, Christiaens P, Tack J
Service de Gastro-entérologie, CHU de Liège, 4000 Liège, Belgique.
Acta Gastroenterol Belg. 2006 Apr-Jun;69(2):203-8.
Frequency of atypical symptoms in patients suffering from gastro-oesophageal reflux disease (GORD) is not well known, and the optimal management of such symptoms has not been well established. Our aims were to set up an observatory of these atypical symptoms of GORD in Belgium and to study the efficacy of one month treatment with esomeprazole 40 mg.
Gastroenterologists participating in this observational survey were asked to register every new outpatient with symptoms of GORD during a period of 20 consecutive working days. All patients who reported predominant presence of atypical manifestations of GORD were documented and characterized more in detail. In patients with dominant chest pain or ENT symptoms, a treatment with esomeprazole 40 mg daily during 4 weeks was proposed.
90 gastroenterologists included 2864 patients consulting for symptoms suggestive of GORD, including 776 (27.1%) with dominant atypical symptoms. Endoscopy (performed in 2800 patients) showed significantly less oesophagitis in atypical than in typical GORD patients (68% vs. 81.1%; P < 0.0001). Management of atypical GORD patients appeared to be very heterogeneous. Overall 516/776 patients were included in the open phase of treatment with esomeprazole 40 mg, but data for analysis are only available in 228 patients. After one month, symptoms had disappeared in 57.1% and significantly improved in 26.6%.
Atypical GORD represents a large number of consultations in gastroenterology in Belgium. It is associated with less endoscopic lesions than typical GORD. Its management is heterogeneous reflecting the lack of guidelines on this topic. Response rate after esomeprazole 40 mg for one month in this open uncontrolled trial was high. This result warrants confirmation in a placebo-controlled trial.
胃食管反流病（GORD）患者非典型症状的发生率尚不清楚，此类症状的最佳治疗方法也未完全确立。我们的目的是在比利时建立一个关于GORD非典型症状的观察站，并研究40毫克埃索美拉唑治疗一个月的疗效。
参与这项观察性调查的胃肠病学家被要求在连续20个工作日内登记每一位有GORD症状的新门诊患者。所有报告主要存在GORD非典型表现的患者都被记录下来并进行更详细的特征描述。对于以胸痛或耳鼻喉症状为主的患者，建议进行为期4周的每日40毫克埃索美拉唑治疗。
90位胃肠病学家纳入了2864例因疑似GORD症状前来咨询的患者，其中776例（27.1%）以非典型症状为主。内镜检查（2800例患者接受了检查）显示，非典型GORD患者的食管炎明显少于典型GORD患者（68%对81.1%；P<0.0001）。非典型GORD患者的治疗方法似乎非常不一致。总体而言，516/776例患者纳入了40毫克埃索美拉唑的开放治疗阶段，但仅有228例患者有可供分析的数据。一个月后，57.1%的患者症状消失，26.6%的患者症状明显改善。
在比利时，非典型GORD在胃肠病学门诊中占了很大比例。与典型GORD相比，其内镜下病变较少。其治疗方法不一致，反映出该主题缺乏指南。在这项开放的非对照试验中，40毫克埃索美拉唑治疗一个月后的缓解率较高。这一结果有待在安慰剂对照试验中得到证实。
