Tytgat G N
Gastroenterology Dept. University of Amsterdam, Academic Medical Center, The Netherlands.
Scand J Gastroenterol Suppl. 1989;168:38-49.
The various therapeutic approaches for reflux oesophagitis are to enhance oesophageal clearance, to coat damaged tissue, to increase the competence of the reflux barrier, to reduce the volume and pH of gastric contents, and to improve gastric emptying and pyloric sphincter competence. Unfortunately, drug therapy of reflux oesophagitis is not yet ideal. Of the prokinetic agents, cisapride is the only drug with proven benefit. Single-agent therapy with the H2-receptor antagonists or sucralfate results in similar degrees of symptom relief and healing. Rapid symptom relief and healing are achieved by omeprazole; however, the significance of sustained achlorhydria remains to be established. Dinnertime dosing of cimetidine appears to be a rational method of suppressing late-evening gastric acidity. Patients with severe or recalcitrant disease should not be treated with conventional therapy alone; the results of controlled studies of combination therapy with the H2-receptor antagonists and sucralfate or cisapride will be viewed with interest.
反流性食管炎的各种治疗方法包括增强食管清除能力、覆盖受损组织、提高反流屏障功能、减少胃内容物的量和酸度，以及改善胃排空和幽门括约肌功能。遗憾的是，反流性食管炎的药物治疗尚未达到理想效果。在促动力药物中，西沙必利是唯一已证实有疗效的药物。使用H2受体拮抗剂或硫糖铝进行单药治疗，症状缓解程度和愈合情况相似。奥美拉唑可快速缓解症状并促进愈合；然而，持续胃酸缺乏的意义仍有待确定。晚餐时服用西咪替丁似乎是抑制傍晚胃酸分泌的合理方法。患有严重或顽固性疾病的患者不应仅接受传统治疗；H2受体拮抗剂与硫糖铝或西沙必利联合治疗的对照研究结果值得关注。
