Kunsch S, Neesse A, Linhart T, Steinkamp M, Fensterer H, Adler G, Gress T M, Ellenrieder V
Department of Gastroenterology, Endocrinology and Metabolism, University of Marburg, Germany.
Z Gastroenterol. 2009 Mar;47(3):277-82. doi: 10.1055/s-2008-1027865. Epub 2009 Mar 11.
Duodeno-gastro-esophageal reflux (DGER) is considered as an independent risk factor for complicated reflux disease (GERD). Patients with Barrett's esophagus have significantly higher levels of DGER than patients with uncomplicated GERD. However, the clinical response to conventional high-dose PPI therapy in patients with uncomplicated GERD and DGER is largely unknown.
30 patients with uncomplicated GERD and combined pathological reflux (acid and bile) were enrolled in the study. Clinical work-up included evaluation of clinical symptoms, esophageal manometry and upper endoscopy. After 6 - 8 weeks of treatment with Pantoprazole 80 mg/d pH measurement and Bilitec 2000 were repeated, and the pattern of symptoms was re-evaluated.
Under treatment with Pantoprazole 80 mg/d acid reflux was normalised in 28 patients (93 %). Similarly the mean percentage of DGER (time with an absorption greater than 0.14) was significantly reduced from 19.6 % (+/- 13.7) to 5.7 % (+/- 7.7, p < 0.05). In 15 patients (50 %) an elevated DGER persisted under treatment with Pantoprazole (DGER-NR group) whereas in 15 cases (50 %) a normalisation could be achieved (DGER-R group). The DGER-NR group had significantly higher levels of bile reflux before (and under) treatment compared to the DGER-R group: 22.9 % (9.98 %) vs. 15.6 % (0.72 %), respectively. Overall, the median quality of life index (QLI) improved from 4.78 (+/- 0.86) before to 8.04 +/- 1.84) under therapy. The clinical response under treatment was marikedly reduced in the DGER-NR group compared to the DGER-R group: QLI 7.3 vs. 8.9. Particularly heartburn and nocturnal coughing persisted.
Our data confirm that high-dose pantoprazole therapy effectively exerts acid suppression in GERD patients with combined pathological reflux. However, DGER could only normalised in 50 % of patients. High levels of DGER at diagnosis enhance the risk of persistent DGER under PPI therapy and are associated with a reduced clinical outcome.
十二指肠-胃-食管反流（DGER）被认为是复杂性反流病（GERD）的一个独立危险因素。巴雷特食管患者的DGER水平显著高于非复杂性GERD患者。然而，非复杂性GERD和DGER患者对传统高剂量质子泵抑制剂（PPI）治疗的临床反应在很大程度上尚不清楚。
30例非复杂性GERD合并病理性反流（酸和胆汁）患者纳入本研究。临床检查包括临床症状评估、食管测压和上消化道内镜检查。用泮托拉唑80mg/d治疗6 - 8周后，重复进行pH测量和Bilitec 2000检测，并重新评估症状模式。
在泮托拉唑80mg/d治疗下，28例患者（93%）的酸反流恢复正常。同样，DGER的平均百分比（吸收大于0.14的时间）从19.6%（±13.7）显著降低至5.7%（±7.7，p<0.05）。15例患者（50%）在泮托拉唑治疗下DGER持续升高（DGER未恢复正常组），而15例患者（50%）可实现正常化（DGER恢复正常组）。与DGER恢复正常组相比，DGER未恢复正常组在治疗前（及治疗期间）的胆汁反流水平显著更高：分别为22.9%（9.98%）和15.6%（0.72%）。总体而言，生活质量指数（QLI）中位数从治疗前的4.78（±0.86）提高到治疗期间的8.04（±1.84）。与DGER恢复正常组相比，DGER未恢复正常组治疗后的临床反应明显降低：QLI分别为7.3和8.9。特别是烧心和夜间咳嗽持续存在。
我们的数据证实，高剂量泮托拉唑治疗可有效抑制合并病理性反流的GERD患者的胃酸分泌。然而，只有50%的患者DGER能够恢复正常。诊断时DGER水平高会增加PPI治疗下DGER持续存在的风险，并与临床疗效降低相关。
