Rasta Medical Centre, Lørenskog, Norway.
Aliment Pharmacol Ther. 2009 Jan;29(2):207-12. doi: 10.1111/j.1365-2036.2008.03877.x. Epub 2008 Oct 22.
It is questionable whether a symptomatic condition with few serious medical consequences requires proton pump inhibitor (PPI) treatment. If effective, a less-potent treatment may be preferable.
To compare an H2-blocker in an effervescent formulation with a PPI in on-demand treatment of endoscopy-negative gastro-oesophageal reflux disease (GERD).
Included were patients with heartburn and/or acid regurgitation for at least 3 months duration, a negative endoscopy and a positive response to 7 days of lansoprazole 60 mg daily. Following pH-metry, the patients were randomized to receive either ranitidine effervescent tablets 75 mg or lansoprazole capsules 15 mg to a maximum of four per day on-demand. The numbers taken were registered monthly for 6 months. If treatment was unsuccessful (lack of efficacy or side effects), patients were registered as failures.
One hundred and three patients were included and 63 were considered for statistical analysis; 32 on lansoprazole and 31 on ranitidine. Seventeen (55%) on ranitidine and four (13%) on lansoprazole failed. The average number of tablets per day was 1.2 in the lansoprazole group and 3.1 in the ranitidine group.
On-demand treatment in patients with endoscopy-negative GERD gives a high success rate with a fairly low dose of PPI. The H2-blocker had significantly less success; nevertheless, almost half were satisfied with the treatment.
对于那些症状轻微且无严重医学后果的病症，是否需要质子泵抑制剂（PPI）治疗存在疑问。如果有效，那么使用效力较弱的治疗方法可能更为理想。
比较按需治疗内镜阴性胃食管反流病（GERD）时，使用质子泵抑制剂和 H2 受体拮抗剂的疗效。
纳入符合以下标准的患者：烧心和/或反酸症状至少持续 3 个月，内镜检查阴性，且对 7 天的兰索拉唑 60mg 每日治疗有阳性反应。进行 pH 监测后，将患者随机分为雷尼替丁泡腾片 75mg 或兰索拉唑胶囊 15mg 组，按需最多服用 4 片/天。记录患者在 6 个月内每月的服药次数。如果治疗无效（无疗效或出现副作用），则将患者记录为失败。
共纳入 103 例患者，其中 63 例纳入统计分析；兰索拉唑组 32 例，雷尼替丁组 31 例。雷尼替丁组中有 17 例（55%）失败，兰索拉唑组中有 4 例（13%）失败。兰索拉唑组的平均日服药片数为 1.2 片，雷尼替丁组为 3.1 片。
内镜阴性 GERD 患者采用按需治疗时，使用低剂量的 PPI 即可获得较高的成功率。H2 受体拮抗剂的成功率明显较低，但仍有近一半的患者对治疗感到满意。
