Ashida K, Sakaguchi M, Tanaka M, Takiuchi H, Egashira Y, Katsu K
Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan.
J Clin Gastroenterol. 1995;20 Suppl 2:S67-71. doi: 10.1097/00004836-199506002-00018.
We studied the gastric acidity, gastric emptying, and proton pump inhibitor (PPI) plasma levels in 10 patients with PPI-resistant ulcers. The pH3 holding-time ratio was low in nine of these patients, with an average ratio of only 39%. PPI plasma levels in those patients were also much lower than in those with nonresistant ulcers. Gastric emptying, determined by the acetaminophen method, was reduced in all 10 patients. Therefore, PPI-resistant ulcers appear to result from insufficient inhibition of gastric acidity, with reduced gastric emptying interfering with the absorption of PPIs. In patients with mild reductions in gastric emptying, PPI plasma levels increased after a change from single-unit enteric-coated tablets (omeprazole) to multiunit enteric-coated granules in capsules (lansoprazole). This change in formulation markedly inhibited gastric acidity and led to rapid healing. In patients with moderate reductions in gastric emptying, doubling the dose of lansoprazole was effective. In patients with severely reduced gastric emptying, there appeared to be a limit to the effectiveness of oral administration of PPIs. Changing the formulation and doubling the dose to compensate for reduced gastric emptying are effective approaches in the treatment of patients with PPI-resistant ulcers.
我们研究了10例质子泵抑制剂（PPI）抵抗性溃疡患者的胃酸度、胃排空及PPI血浆水平。其中9例患者的pH3保持时间比很低，平均比值仅为39%。这些患者的PPI血浆水平也远低于非抵抗性溃疡患者。采用对乙酰氨基酚法测定，所有10例患者的胃排空均减慢。因此，PPI抵抗性溃疡似乎是由于胃酸抑制不足，胃排空减慢干扰了PPI的吸收所致。在胃排空轻度减慢的患者中，从单单位肠溶片（奥美拉唑）改为多单位肠溶胶囊颗粒（兰索拉唑）后，PPI血浆水平升高。这种剂型改变显著抑制了胃酸度并促使溃疡快速愈合。在胃排空中度减慢的患者中，将兰索拉唑剂量加倍有效。在胃排空严重减慢的患者中，口服PPI的有效性似乎存在限度。改变剂型并加倍剂量以补偿胃排空减慢是治疗PPI抵抗性溃疡患者的有效方法。
