Department of Medicine and Institute of Neurogastroenterology, Academic Teaching Hospital Martin Luther, Charité - Universitätsmedizin Berlin, Caspar-Theyß-Str, 27-31, Berlin, 14193, Germany.
BMC Gastroenterol. 2013 Oct 1;13:145. doi: 10.1186/1471-230X-13-145.
Symptoms suggestive of functional dyspepsia (FD) and irritable bowel syndrome (IBS) frequently overlap with those of gastroesophageal reflux disease. Despite the high prevalence of symptomatic overlap, the underlying etiology remains poorly defined. We assessed the correlation of symptomatic relief and health-related quality of life (HRQoL) with healing of reflux esophagitis to further derive insights into the underlying etiology.
626 patients with reflux esophagitis were enrolled into one of two treatment groups (classical healing concept or the complete remission concept) to investigate differences in treatment intensity. Patients were treated with pantoprazole until esophageal mucosal healing. Remission was followed for up to 6 months without treatment. Gastro-intestinal symptoms and HRQoL were analyzed using disease-specific, psychometrically validated patient-reported outcome instruments (ReQuest™, GERDyzer™).
Symptomatic burden reflected by ReQuest™ substantially decreased from baseline to end of treatment by 83% and 88% in either treatment group, respectively. ReQuest™ scores significantly decreased in patients with or without heartburn and in those with symptoms suggestive of FD and IBS, indicating response of all symptom categories to treatment (p < 0.005). Therapy-associated relief of symptoms was paralleled by substantial gains in HRQoL, which continued to stabilize post-treatment.
Pantoprazole is effective in relieving upper and lower gastro-intestinal symptoms overlapping with erosive esophagitis, and provides sustained improvement in HRQoL post-treatment. Our results propose a link between both healing of erosive esophagitis and the slower remission of upper and lower gastro-intestinal symptoms. Since the improvement observed is likely to be multifactorial, the possibility for an immune-mediated etiology and identification of putative susceptibility factors by genome-wide association study may provide focus for future research.
ClinicalTrials.gov identifier: NCT00325676.
功能性消化不良（FD）和肠易激综合征（IBS）的症状常与胃食管反流病（GERD）的症状重叠。尽管症状重叠的患病率很高，但潜在病因仍未明确定义。我们评估了症状缓解与健康相关生活质量（HRQoL）与反流性食管炎愈合的相关性，以进一步深入了解潜在病因。
626 例反流性食管炎患者被纳入两种治疗组（经典愈合概念或完全缓解概念）之一，以研究治疗强度的差异。患者接受泮托拉唑治疗，直至食管黏膜愈合。在不进行治疗的情况下，持续缓解期长达 6 个月。使用特定于胃肠道的、经过心理测量验证的患者报告结局工具（ReQuest™、GERDyzer™）分析胃肠症状和 HRQoL。
无论在何种治疗组中，ReQuest™反映的症状负担从基线到治疗结束时分别下降了 83%和 88%。有或没有烧心症状、有或没有 FD 和 IBS 症状的患者的 ReQuest™评分均显著下降，表明所有症状类别均对治疗有反应（p<0.005）。治疗相关的症状缓解与 HRQoL 的显著改善相平行，并在治疗后继续稳定。
泮托拉唑可有效缓解重叠性糜烂性食管炎的上、下胃肠道症状，并在治疗后持续改善 HRQoL。我们的结果表明，糜烂性食管炎的愈合与上、下胃肠道症状的缓解较慢之间存在联系。由于观察到的改善可能是多因素的，因此通过全基因组关联研究确定免疫介导的病因和潜在易感性因素可能是未来研究的重点。
ClinicalTrials.gov 标识符：NCT00325676。
