Marciano-D'Amore D A, Paterson W G, Da Costa L R, Beck I T
Gastrointestinal Diseases Research Unit, Hotel Dieu Hospital, Kingston, Ontario, Canada.
J Clin Gastroenterol. 1990 Dec;12(6):616-20. doi: 10.1097/00004836-199012000-00003.
We conducted a retrospective review of 25 patients with severe reflux esophagitis treated with omeprazole because of failure of H2 receptor antagonists to heal their esophagitis. Prior to beginning omeprazole (40 mg/day), all patients were on H2 antagonists for at least 9 months and still had endoscopic evidence of longitudinal (grade II) or circumferential (grade III) distal esophageal ulceration. Omeprazole therapy brought about complete endoscopic healing in 24 of 25 patients (96%). Twenty-three of 24 healed patients were then restarted on H2 antagonists as maintenance therapy. Repeat endoscopy was performed if symptoms recurred. Fourteen of 24 patients (58%) had recurrence of endoscopic esophagitis documented between 26 and 300 days from the time of starting maintenance therapy. Two of these 14 patients opted for antireflux surgery, whereas the remaining 12 were once again given omeprazole, which again resulted in symptom resolution in all patients. These data suggest that most patients with H2 receptor antagonist-resistant ulcerative esophagitis cannot be successfully maintained on H2 antagonists even after the ulcers have been healed with omeprazole. Further studies are required to determine the role of omeprazole compared to other treatments in the long-term maintenance therapy of these patients.
我们对25例因H2受体拮抗剂治疗食管炎失败而接受奥美拉唑治疗的重度反流性食管炎患者进行了回顾性研究。在开始使用奥美拉唑（40毫克/天）之前，所有患者均服用H2拮抗剂至少9个月，但仍有内镜检查证据显示食管远端存在纵向（II级）或环形（III级）溃疡。奥美拉唑治疗使25例患者中的24例（96%）内镜下完全愈合。24例愈合患者中的23例随后重新开始服用H2拮抗剂作为维持治疗。如果症状复发，则进行重复内镜检查。24例患者中有14例（58%）在开始维持治疗后的26至300天内出现内镜下食管炎复发。这14例患者中有2例选择了抗反流手术，而其余12例再次接受奥美拉唑治疗，所有患者症状再次缓解。这些数据表明，大多数对H2受体拮抗剂耐药的溃疡性食管炎患者即使在溃疡已用奥美拉唑治愈后，也无法成功地用H2拮抗剂维持治疗。需要进一步研究以确定与其他治疗方法相比，奥美拉唑在这些患者长期维持治疗中的作用。
