Department of Internal Medicine, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
J Gastroenterol. 2010 Dec;45(12):1193-200. doi: 10.1007/s00535-010-0276-7. Epub 2010 Jul 6.
Despite low gastric acid secretion levels among elderly people and Helicobacter pylori-positive individuals in Japan, many patients suffer from endoscopic relapse of erosive gastroesophageal reflux disease (GERD) during standard-dose proton pump inhibitor (PPI) maintenance therapy. We aimed to investigate the relapse rate and risk factors for relapse during long-term PPI therapy in a prospective multicenter study.
Patients diagnosed endoscopically as having erosive GERD according to the Los Angeles (LA) classification, with remission under PPI medication, and without mucosal damage in the esophagus, were enrolled and took rabeprazole 10 mg/day, the standard dose in Japan, for up to 104 weeks, with endoscopy at weeks 24, 52, 76, and 104; erosive GERD with LA classification grade A, B, C, or D was defined as relapse.
The baseline status of the 191 cases analyzed was: female (34.6%), ≥65 years old (50.8%), H. pylori-positive (40.8%), body mass index (BMI) ≥25 kg/m(2) (35.6%), and hiatus hernia (79.6%). Relapse occurred by week 104 in 21 cases (11%; 12 females, 9 males). Risk factors were hiatus hernia; severe past erosive GERD (grade C or D); H. pylori-negative; no mucosal atrophy; nonsmoking; and being female and <150 cm in height.
This study revealed the significant risk factors that might be monitored during long-term maintenance therapy to prevent relapse of GERD.
尽管在日本，老年人和幽门螺杆菌阳性者的胃酸分泌水平较低，但许多患者在质子泵抑制剂（PPI）标准剂量维持治疗期间仍会出现内镜下复发性糜烂性胃食管反流病（GERD）。我们旨在通过一项前瞻性多中心研究，调查长期 PPI 治疗期间的复发率和复发危险因素。
根据洛杉矶（LA）分类，内镜诊断为糜烂性 GERD 的患者（缓解期 PPI 治疗，食管无黏膜损伤）被纳入研究，接受雷贝拉唑 10mg/天（日本标准剂量）治疗，最长 104 周，在第 24、52、76 和 104 周进行内镜检查；LA 分类等级 A、B、C 或 D 的糜烂性 GERD 定义为复发。
191 例分析病例的基线状态为：女性（34.6%）、年龄≥65 岁（50.8%）、幽门螺杆菌阳性（40.8%）、体重指数（BMI）≥25kg/m2（35.6%）和食管裂孔疝（79.6%）。104 周时有 21 例（11%；12 例女性，9 例男性）出现复发。危险因素包括食管裂孔疝、严重既往糜烂性 GERD（等级 C 或 D）、幽门螺杆菌阴性、无黏膜萎缩、不吸烟、女性和身高<150cm。
本研究揭示了长期维持治疗期间可能需要监测的显著危险因素，以预防 GERD 复发。
