Aanen Marissa C, Weusten Bas L A M, Numans Mattijs E, de Wit Niek J, Samsom Melvin, Smout André J P M
Gastrointestinal Research Unit University Medical Center, Utrecht, the Netherlands.
J Clin Gastroenterol. 2008 May-Jun;42(5):441-7. doi: 10.1097/MCG.0b013e318074dd62.
Gastroesophageal reflux disease patients demonstrate various pathophysiologic backgrounds. Therefore, a heterogeneous response to proton-pump inhibitor (PPI) treatment can be expected. We investigated the effect of short-term PPI treatment on symptoms and quality of life (QOL) in primary care patients with and without pathologic esophageal acid exposure and in presence or absence of a positive association between symptoms and reflux episodes.
Seventy-four heartburn patients were categorized into 4 groups according to positive or negative symptom-reflux association, as expressed in symptom index, symptom sensitivity index, and symptom association probability (SAP) and presence or absence of pathologic reflux, defined as esophageal pH<4%>6% of the time (pH+/pH-). Overall and specific reflux symptoms were assessed 1 week before and the last week during a 2-week course of 40-mg esomeprazole daily. The QOL was scored by the Quality of Life in Reflux and Dyspepsia questionnaire 2 weeks before treatment and directly after.
Using the SAP to assess symptom-reflux associations, the 4 groups [SAP+pH+(n=40); SAP+pH-(n=12); SAP-pH+(n=10); SAP-pH-(n=10)] had similar demographic characteristics. The SAP-pH- subgroup had the least overall symptom reduction (P<0.01) and in the SAP+pH+ subgroup the greatest heartburn symptom reduction was found (P<0.02). The residual symptom scores on treatment were lowest in SAP+pH+ and highest in SAP-pH- subgroups and relatively high in the SAP+pH-. QOL was severely reduced and SAP-pH- patients had the lowest QOL overall. Similar findings were made using symptom index and symptom sensitivity index.
Symptomatic reflux patients without evidence of reflux disease on a 24-hour pH recording responded less favorably to PPI treatment than patients with a positive symptom-reflux association or with pathologic reflux.
胃食管反流病患者表现出多种病理生理背景。因此，可以预期对质子泵抑制剂（PPI）治疗会有不同的反应。我们研究了短期PPI治疗对基层医疗中有无病理性食管酸暴露以及症状与反流发作之间有无正相关关系的患者的症状和生活质量（QOL）的影响。
74名烧心患者根据症状指数、症状敏感性指数和症状关联概率（SAP）所表达的症状与反流的正或负关联以及病理性反流的有无（定义为食管pH<4%>6%的时间（pH+/pH-））分为4组。在每天服用40 mg埃索美拉唑的2周疗程前1周和最后1周评估总体和特定反流症状。在治疗前2周和治疗后直接用反流和消化不良生活质量问卷对生活质量进行评分。
使用SAP评估症状与反流的关联，4组[SAP+pH+（n = 40）；SAP+pH-（n = 12）；SAP-pH+（n = 10）；SAP-pH-（n = 10）]具有相似的人口统计学特征。SAP-pH-亚组总体症状减轻最少（P<0.01），而在SAP+pH+亚组中烧心症状减轻最大（P<0.02）。治疗后的残余症状评分在SAP+pH+亚组中最低，在SAP-pH-亚组中最高，在SAP+pH-亚组中相对较高。生活质量严重降低，SAP-pH-患者总体生活质量最低。使用症状指数和症状敏感性指数也有类似发现。
24小时pH记录无反流病证据的有症状反流患者对PPI治疗的反应不如症状与反流呈正相关或有病理性反流的患者。
