Daneshmend T K, Prichard P J, Bhaskar N K, Millns P J, Hawkey C J
Department of Therapeutics, University Hospital, Nottingham, United Kingdom.
Gastroenterology. 1989 Oct;97(4):944-9. doi: 10.1016/0016-5085(89)91502-3.
We have developed an ultrathin endoscope for repeated endoscopy in unsedated subjects and used it with assessment of bleeding rates to investigate aspirin-induced gastric mucosal injury and its prevention by famotidine. Compared with placebo, 900 mg of aspirin b.i.d. taken for 48 h caused significant endoscopic injury (median grade 3.5, interquartile range 2-4, modified Lanza scale, p less than 0.01), with an increase in mucosal bleeding from 2.0 (geometric mean; 95% confidence limits, 1.1-3.9) microliters/12 min, to 8.3 (2.4-28.8) microliters/12 min (p less than 0.05). Famotidine (20 mg b.i.d.) raised intragastric pH and reduced endoscopic antral injury (median 1.5, interquartile range 0.5-2, p less than 0.05) and bleeding [3.1 (1.2-8.3) microliters/12 min, p less than 0.01] to levels not significantly different from placebo [1 (0-1) and 2.0 (1.1-3.9) microliters/12 min, respectively]. By contrast, 2 mg of famotidine b.i.d. had no significant effect on intragastric pH endoscopic injury or bleeding rates. The two assessments of gastric mucosal injury correlated strongly (r = 0.71, p less than 0.01). The reduction in bleeding with famotidine tended to be higher, the greater the intragastric pH (r = 0.66, p = 0.057). Ultrathin endoscopy is a simple technique that validates gastric mucosal bleeding as a measure of acute gastric mucosal injury in humans. Acid suppression is an effective method of ameliorating this injury.
我们研发了一种超薄内窥镜，用于对未使用镇静剂的受试者进行重复内镜检查，并结合出血率评估来研究阿司匹林诱导的胃黏膜损伤以及法莫替丁对其的预防作用。与安慰剂相比，每天两次服用900毫克阿司匹林，持续48小时会导致明显的内镜损伤（中位数为3.5级，四分位间距为2 - 4，改良兰扎量表，p小于0.01），黏膜出血从2.0（几何平均数；95%置信区间，1.1 - 3.9）微升/12分钟增加到8.3（2.4 - 28.8）微升/12分钟（p小于0.05）。法莫替丁（每日两次，每次20毫克）提高了胃内pH值，减轻了内镜下胃窦损伤（中位数为1.5，四分位间距为0.5 - 2，p小于0.05），并使出血情况[3.1（1.2 - 8.3）微升/12分钟，p小于0.01]降低至与安慰剂[分别为1（0 - 1）和2.0（1.1 - 3.9）微升/12分钟]无显著差异的水平。相比之下，每日两次服用2毫克法莫替丁对胃内pH值、内镜损伤或出血率没有显著影响。胃黏膜损伤的两种评估方法具有很强的相关性（r = 0.71，p小于0.01）。法莫替丁导致的出血减少趋势越高，胃内pH值越高（r = 0.66，p = 0.057）。超薄内镜检查是一种简单的技术，可验证胃黏膜出血作为人类急性胃黏膜损伤指标的有效性。抑酸是改善这种损伤的有效方法。
