洛杉矶 C 和 D 级反流性食管炎的愈合模型：为达到最大愈合效果，抑酸的最佳时间是否存在？
A model of healing of Los Angeles grades C and D reflux oesophagitis: is there an optimal time of acid suppression for maximal healing?
机构信息
Albert Einstein Medical Center, Philadelphia, PA 19141, USA.
出版信息
Aliment Pharmacol Ther. 2010 Aug;32(3):443-7. doi: 10.1111/j.1365-2036.2010.04367.x. Epub 2010 May 22.
BACKGROUND
In patients with Los Angeles (LA) grade C or D oesophagitis, a positive relationship has been established between the duration of intragastric acid suppression and healing.
AIM
To determine whether there is an apparent optimal time of intragastric acid suppression for maximal healing of reflux oesophagitis.
METHODS
Post hoc analysis of data from a proof-of-concept, double-blind, randomized study of 134 adult patients treated with esomeprazole (10 or 40 mg od for 4 weeks) for LA grade C or D oesophagitis. A curve was fitted to pooled 24-h intragastric pH (day 5) and endoscopically assessed healing (4 weeks) data using piecewise quadratic logistic regression.
RESULTS
Maximal reflux oesophagitis healing rates were achieved when intragastric pH >4 was achieved for approximately 50-70% (12-17 h) of the 24-h period. Acid suppression above this threshold did not yield further increases in healing rates.
CONCLUSION
After 4 weeks' acid-suppressive therapy for LA grade C or D oesophagitis, successful healing appears to reach a threshold above which improvements are unlikely to be achieved despite an increase in number of hours with intragastric pH >4.
背景
在洛杉矶（LA）C 或 D 级食管炎患者中，胃内酸抑制的持续时间与愈合之间存在正相关关系。
目的
确定胃内酸抑制是否存在明显的最佳时间，以实现反流性食管炎的最大愈合。
方法
对接受埃索美拉唑（10 或 40mg，每日 1 次，持续 4 周）治疗的 134 例成人 LA C 或 D 级食管炎患者的概念验证、双盲、随机研究数据进行事后分析。使用分段二次逻辑回归拟合 24 小时胃内 pH（第 5 天）和内镜评估愈合（4 周）数据的曲线。
结果
当 24 小时内胃内 pH >4 的时间约占 50-70%（12-17 小时）时，可实现最大反流性食管炎愈合率。超过此阈值的酸抑制不会进一步增加愈合率。
结论
在 LA C 或 D 级食管炎进行 4 周的酸抑制治疗后，尽管胃内 pH >4 的时间增加，但愈合似乎达到了一个阈值，超过该阈值不太可能再有所改善。
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