Lishchuk N B, Simanenkov V I, Tikhonov S V
I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint Petersburg, Russia.
Ter Arkh. 2017;89(4):57-63. doi: 10.17116/terarkh201789457-63.
To investigate the clinical and pathogenetic features of the non-acidic types of gastroesophageal reflux disease (GERD) and to evaluate the impact of combined therapy versus monotherapy on the course of this disease.
The investigation enrolled 62 patients with non-acidic GERD. The follow-up period was 6 weeks. The patients were divided into 2 groups: 1) weakly acidic gastroesophageal refluxes (GER); 2) weakly alkaline GER. Then each group was distributed, thus making up 4 groups: 1) 19 patients with weakly acidic GER who received monotherapy with rabeprazole 20 mg/day; 2) 21 patients with weakly acidic GER had combined therapy with rabeprazole 20 mg and itopride; 3) 8 patients with weakly alkaline GER who received ursodeoxycholic acid (UDCA) monotherapy; and 4) 14 patients with weakly alkaline GER who had combined therapy with UDCA and itopride, The clinical symptoms of the disease, the endoscopic pattern of the upper gastrointestinal tract (GIT) mucosa, histological changes in the esophageal and gastric mucosa, and the results of 24-hour impedance pH monitoring were assessed over time.
During differentiation therapy, the majority of patients reported positive clinical changes and an improved or unchanged endoscopic pattern. Assessment of impedance pH monitoring results revealed decreases in the overall number of GERs, the presence of a bolus in the esophagus, and the number of proximal refluxes. These changes were noted not only in patients taking proton pump inhibitors (PPIs), but also in those treated with UDCA monotherapy or combined PPI and prokinetic therapy.
A differentiated approach to non-acidic GER treatment contributes to its efficiency. Adding the prokinetic itomed (itopride hydrochloride) to PPI therapy in a patient with weakly acidic GER enhances the efficiency of treatment, by positively affecting upper GIT motility. The mainstay of therapy for GERD with a predominance of weakly alkaline refluxes is UDCA, the combination of the latter and the prokinetic can exert a more pronounced effect on the clinical and endoscopic pattern and upper GIT motility.
研究非酸性类型胃食管反流病（GERD）的临床和发病机制特点，并评估联合治疗与单一疗法对该病病程的影响。
该研究纳入了62例非酸性GERD患者。随访期为6周。患者被分为2组：1）弱酸性胃食管反流（GER）；2）弱碱性GER。然后每组再进行细分，共形成4组：1）19例弱酸性GER患者接受雷贝拉唑20mg/天的单一疗法；2）21例弱酸性GER患者接受雷贝拉唑20mg与伊托必利的联合治疗；3）8例弱碱性GER患者接受熊去氧胆酸（UDCA）单一疗法；4）14例弱碱性GER患者接受UDCA与伊托必利的联合治疗。随着时间推移，评估了疾病的临床症状、上消化道（GIT）黏膜的内镜表现、食管和胃黏膜的组织学变化以及24小时阻抗pH监测结果。
在分化治疗期间，大多数患者报告临床症状有积极变化，内镜表现改善或未改变。对阻抗pH监测结果的评估显示，GER的总数、食管内团块的存在以及近端反流的数量均有所减少。这些变化不仅在服用质子泵抑制剂（PPI）的患者中出现，在接受UDCA单一疗法或PPI与促动力药联合治疗的患者中也被观察到。
对非酸性GER进行差异化治疗有助于提高治疗效果。在弱酸性GER患者的PPI治疗中添加促动力药伊托美（盐酸伊托必利），通过对上GIT动力产生积极影响，提高了治疗效率。以弱碱性反流为主的GERD治疗的主要药物是UDCA，后者与促动力药联合使用对临床和内镜表现以及上GIT动力可产生更显著的效果。
