Fiasse R, Druez P, Coppens J P, Delhaze M, Fabre C, Pauwels S, Dive C
Service de Gastro-entérologie, Cliniques St-Luc, Université Catholique de Louvain, Bruxelles.
Acta Gastroenterol Belg. 1990 Sep-Dec;53(5-6):573-84.
In 42 patients (25 men, 17 women, mean age 62 years) with severe erosive or ulcerative oesophagitis not responding to H2-receptor antagonist treatment over at least 3 months and ineligible for surgery, omeprazole was administered at an initial dose of 40 mg/day, subsequently reduced to 20 mg after healing of the lesions. Patients had monthly clinical, endoscopic, histological and laboratory assessment over the healing period, then were reevaluated 3-monthly over one year, then 6-monthly, during the maintenance treatment. Stages of oesophagitis were based on the Savary-Miller classification, modified for stage I (erosions must be present). With 40 mg omeprazole, healing was observed in 71%, 83% and 90% of the patients after 1, 2 and 3 months of treatment, respectively. After one month of treatment, a complete healing was less frequently observed in patients with stage IV oesophagitis pre-trial (55%) than in the patients with stages I, II and III pre-trial (90%) (p less than 0.05). Ninety per cent of the patients healed at one month were asymptomatic whereas 50% of the patients with incomplete healing still had symptoms, most often dysphagia, rarely heartburn. Maintenance treatment with 20 mg was sufficient in most patients, with a probability of remaining healed of 69% from 9 to 24 months after starting this dosage. In 9 patients with Barrett's oesophagus, the lengths of the circumferential metaplasia were found to be reduced after one year of treatment compared to pre-trial lengths (p less than 0.005). There was no further significant reduction of length after 2 years of treatment. Fasting gastrin was increased in most of the patients, although great inter-patient variability was observed; 50% of the patients had levels not exceeding 5 times the upper limit of normal. There was no consistent increase of enterochromaffin-like cell density in 29 patients investigated up to nearly 2 years of omeprazole administration. The treatment was well tolerated. By inducing a profound and sustained inhibition of acid secretion, as confirmed by pH monitoring, omeprazole promotes healing of the lesions of severe oesophagitis and prevents recurrence of lesions and symptoms. Omeprazole is therefore a valuable treatment for patients ineligible for surgery, particularly in the elderly.
42例（25例男性，17例女性，平均年龄62岁）患有严重糜烂性或溃疡性食管炎的患者，至少3个月来对H2受体拮抗剂治疗无反应且不符合手术条件，给予奥美拉唑初始剂量为40mg/天，病变愈合后减至20mg。在愈合期患者每月进行临床、内镜、组织学和实验室评估，然后在维持治疗期间，在1年中每3个月重新评估一次，之后每6个月评估一次。食管炎分期基于Savary-Miller分类，并对I期进行了修改（必须存在糜烂）。使用40mg奥美拉唑治疗1、2和3个月后，分别有71%、83%和90%的患者观察到愈合。治疗1个月后，治疗前IV期食管炎患者（55%）比治疗前I、II和III期患者（90%）较少观察到完全愈合（p<0.05）。1个月时愈合的患者中有90%无症状，而愈合不完全的患者中有50%仍有症状，最常见的是吞咽困难，很少有烧心。大多数患者使用20mg进行维持治疗就足够了，从开始使用该剂量起9至24个月内仍保持愈合的概率为69%。在9例巴雷特食管患者中，发现治疗1年后与治疗前相比，环形化生的长度缩短（p<0.005）。治疗2年后长度没有进一步显著缩短。大多数患者空腹胃泌素升高，尽管观察到患者之间存在很大差异；50%的患者水平不超过正常上限的5倍。在接受近2年奥美拉唑治疗的29例患者中，肠嗜铬样细胞密度没有持续一致的增加。该治疗耐受性良好。通过pH监测证实，奥美拉唑可诱导对胃酸分泌的深度和持续抑制，促进严重食管炎病变的愈合并防止病变和症状复发。因此，奥美拉唑对于不符合手术条件的患者，尤其是老年患者，是一种有价值的治疗方法。
