Schiessel R, Starlinger M, Appel W H, Schemper M
Wien Klin Wochenschr. 1986 May 30;98(11):341-5.
In a prospective long-term study the feasibility of conservative management of peptic oesophageal stenosis was investigated. Admission criteria were: endoscopic-bioptic evidence of peptic stricture of the oesophagus, acid gastro-oesophageal reflux on pH-metry, high operative risk or previous unsuccessful antireflux operation. Therapy consisted of two components: 1. bouginage of the stricture up to 38 to 45 French; 2. inhibition of gastric secretion by 4 X 400 mg daily cimetidine. A total of 33 patients were entered into the study; 28 were followed up for more than 6 months, the mean follow-up period being 15 months. Out of the 28 patients 16 were clinically free of symptoms, 5 had evident symptoms, 3 needed rebouginage and the remaining 4 were clear failures and had to be operated on because of persistent severe pain or rapid restenosis. Considerable improvement in reflux oesophagitis was obtained in 61.5% of cases; indeed, complete healing was noted in 46% of patients at follow-up. Both the clinical and endoscopic outcome were influenced by compliance. Irregular taking of cimetidine impaired results significantly (p less than 0.001 X2-test) and raised the frequency of rebouginage. These results show that 86% of cases with the most severe form of reflux oesophagitis were managed successfully by conservative therapy and that only the remaining few cases needed surgery.
在一项前瞻性长期研究中，对消化性食管狭窄保守治疗的可行性进行了调查。纳入标准为：食管消化性狭窄的内镜活检证据、pH值测定显示有胃酸胃食管反流、手术风险高或既往抗反流手术失败。治疗包括两个部分：1. 用38至45法式探条扩张狭窄；2. 每天服用4次，每次400毫克西咪替丁抑制胃酸分泌。共有33例患者进入研究；28例随访超过6个月，平均随访期为15个月。在这28例患者中，16例临床无症状，5例有明显症状，3例需要再次扩张，其余4例明显治疗失败，因持续严重疼痛或快速再狭窄而必须接受手术。61.5%的病例反流性食管炎有显著改善；事实上，随访时46%的患者完全愈合。临床和内镜结果均受依从性影响。不规则服用西咪替丁显著影响治疗效果（P<0.001，卡方检验），并增加了再次扩张的频率。这些结果表明，86%最严重形式的反流性食管炎病例通过保守治疗成功治愈，只有少数其余病例需要手术。
