Department of Gastroenterology, Endocrinology and Metabolism, Faculty of Medicine, Philipps University of Marburg, Marburg, Germany.
Digestion. 2012;86(4):315-22. doi: 10.1159/000342234. Epub 2012 Nov 1.
Duodenogastroesophageal reflux (DGER) is considered an independent risk factor for complicated reflux disease (gastroesophageal reflux disease; GERD). However, the role of DGER in GERD patients refractory to proton pump inhibitors (PPI) remains poorly understood.
85 patients with clinical reflux symptoms and a history of ineffective response to PPIs were enrolled in the study. Patients with elevated reflux measurement (pH and/or Bilitec measurement; n = 47) received pantoprazole 80 mg for 8 weeks. Clinical outcome was defined as response (≤2 symptoms/week) or nonresponse (≥3 symptoms/week).
Of the 47 patients with elevated reflux measurement, 30 were classified as responders and 17 as nonresponders. Treatment with pantoprazole resulted in a significant reduction of acidic reflux in both PPI responders and PPI nonresponders. In contrast, DGER was only significantly reduced in the PPI responder group (22.8 ± 22.8 vs. 6.6 ± 10.8%; p < 0.05) but not in the PPI nonresponder group (24.5 ± 18.6 vs. 22.2 ± 12.7%; p > 0.05).
The presented study firstly describes that nonresponsiveness to PPI is associated with a limited effect of PPIs on reducing DGER. Thus, persistent DGER may play a key role in mediating reflux symptoms refractory to high-dose PPIs.
十二指肠胃食管反流（DGER）被认为是复杂反流病（胃食管反流病；GERD）的独立危险因素。然而，DGER 在质子泵抑制剂（PPI）治疗无效的 GERD 患者中的作用仍知之甚少。
本研究纳入了 85 例有临床反流症状且 PPI 治疗无效的患者。反流测量值升高（pH 和/或 Bilitec 测量；n=47）的患者接受泮托拉唑 80mg 治疗 8 周。临床疗效定义为应答（≤2 症状/周）或无应答（≥3 症状/周）。
在 47 例反流测量值升高的患者中，30 例为应答者，17 例为无应答者。泮托拉唑治疗可显著减少 PPI 应答者和 PPI 无应答者的酸性反流。相比之下，DGER 仅在 PPI 应答者组中显著降低（22.8±22.8 比 6.6±10.8%；p<0.05），而在 PPI 无应答者组中无显著降低（24.5±18.6 比 22.2±12.7%；p>0.05）。
本研究首次描述了 PPI 无应答与 PPI 降低 DGER 的作用有限有关。因此，持续的 DGER 可能在介导对高剂量 PPI 治疗无效的反流症状中发挥关键作用。
