Fiorucci S, Santucci L, Farroni F, Pelli M A, Morelli A
Department of Internal Medicine, Perugia University, Italy.
Am J Gastroenterol. 1989 Oct;84(10):1263-7.
Pattern of gastric and esophageal acidity were evaluated in 14 patients with endoscopically and histologically proven Barrett's esophagus, in 46 with slight-to-moderate esophagitis, and in 22 healthy subjects. In patients with Barrett's esophagus, LES pressure was considerably lower and percentage exposure to acid was considerably higher than in either patients with esophagitis or controls (p less than 0.001). Percentage of time with esophageal pH below 4 was 33.2% in patients with Barrett's esophagus, 14% in patients with slight-to-moderate esophagitis (p less than 0.001), and 3.4% in controls (p less than 0.001). In patients with Barrett's esophagus, the esophageal exposure to acid was similar in upright and supine positions, and the number of refluxes that lasted longer than 5 min was also greater in these patients than in uncomplicated esophagitis or controls (p less than 0.001). Accordingly, their acid-clearing capacity was markedly reduced (p less than 0.001 vs. control). Omeprazole 20 mg, given once daily, reduced both percentage of time with pH below 4 (p less than 0.001) and the number of episodes longer than 5 min (p less than 0.001), but had no effect on acid clearance. In patients with Barrett's esophagus, omeprazole lowered intragastric acidity by 77.8% (p less than 0.001). Median intragastric pH was 1.9 (1.7-2.1) pretreatment, and 4.5 (4.2-5) during omeprazole (p less than 0.001).
对14例经内镜和组织学证实患有巴雷特食管的患者、46例患有轻至中度食管炎的患者以及22名健康受试者的胃和食管酸度模式进行了评估。与食管炎患者或对照组相比，巴雷特食管患者的LES压力明显更低，酸暴露百分比明显更高（p<0.001）。巴雷特食管患者食管pH值低于4的时间百分比为33.2%，轻至中度食管炎患者为14%（p<0.001），对照组为3.4%（p<0.001）。在巴雷特食管患者中，食管在直立位和仰卧位时的酸暴露情况相似，且这些患者中持续时间超过5分钟的反流次数也比单纯性食管炎患者或对照组更多（p<0.001）。因此，他们的酸清除能力明显降低（与对照组相比，p<0.001）。每日服用一次20毫克奥美拉唑可降低pH值低于4的时间百分比（p<0.001）以及持续时间超过5分钟的发作次数（p<0.001），但对酸清除无影响。在巴雷特食管患者中，奥美拉唑可使胃内酸度降低77.8%（p<0.001）。奥美拉唑治疗前胃内pH值中位数为1.9（1.7 - 2.1），服用奥美拉唑期间为4.5（4.2 - 5）（p<0.001）。
