Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, SA, Australia.
Aliment Pharmacol Ther. 2010 Oct;32(8):1023-30. doi: 10.1111/j.1365-2036.2010.04428.x. Epub 2010 Aug 15.
Acid reflux is often difficult to control medically.
To assess the effect of 40 mg twice daily esomeprazole (high-dose) on gastric and oesophageal pH and symptoms, and biomarkers relevant to adenocarcinoma, in patients with Barrett's oesophagus (BO).
Eighteen patients, treated with proton pump inhibitors as prescribed by their treating doctor, had their therapy increased to high-dose esomeprazole for 6 months.
At entry into the study, 9/18 patients had excessive 24-h oesophageal acid exposure, and gastric pH remained <4 for >16 h in 8/18. With high-dose esomeprazole, excessive acid exposure occurred in 2/18 patients, and gastric pH <4 was decreased from 38% of overall recording time and 53% of the nocturnal period to 15% and 17%, respectively (P < 0.001). There was a reduction in self-assessed symptoms of heartburn (P = 0.0005) and regurgitation (P < 0.0001), and inflammation and proliferation in the Barrett's mucosa. There was no significant change in p53, MGMT or COX-2 expression, or in aberrant DNA methylation.
High-dose esomeprazole achieved higher levels of gastric acid suppression and control of oesophageal acid reflux and symptoms, with significant decreases in inflammation and epithelial proliferation. There was no reversal of aberrant DNA methylation.
酸反流常常难以通过医学手段进行控制。
评估每日两次、每次 40 毫克埃索美拉唑（高剂量）对 Barrett 食管（BO）患者胃和食管 pH 值及症状的影响，以及与腺癌相关的生物标志物。
18 例患者在接受其主治医生开具的质子泵抑制剂治疗的基础上，将治疗方案升级为高剂量埃索美拉唑，疗程为 6 个月。
在入组时，18 例患者中有 9 例存在 24 小时食管酸暴露过度，8 例存在胃 pH 值<4 的时间超过 16 小时。采用高剂量埃索美拉唑治疗后，2 例患者出现酸暴露过度，胃 pH 值<4 的时间从总记录时间的 38%和夜间的 53%分别降至 15%和 17%（P<0.001）。患者自评的烧心（P=0.0005）和反流（P<0.0001）症状减轻，Barrett 食管黏膜的炎症和增生减少。p53、MGMT 或 COX-2 表达以及异常 DNA 甲基化均无显著变化。
高剂量埃索美拉唑可实现更高水平的胃酸抑制和食管酸反流及症状控制，显著降低炎症和上皮增生。异常 DNA 甲基化未发生逆转。
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