Klinkenberg-Knol E C, Festen H P, Meuwissen S G
Department of Gastroenterology, Free University Hospital, Amsterdam, The Netherlands.
Drugs. 1995 May;49(5):695-710. doi: 10.2165/00003495-199549050-00005.
Gastro-oesophageal reflux disease (GORD) ranges from episodic symptomatic reflux without oesophagitis to severe oesophageal mucosal damage, such as Barrett's metaplasia or peptic stricture. The multifactorial pathogenesis of GORD prevents medical cure of the disease. GORD is a chronic disease with a high tendency to relapse, requiring a long term treatment strategy in practically all patients. Complete healing of all mucosal lesions is not necessarily the aim of treatment in all patients. In milder forms of reflux disease, symptom relief is the most important goal. Many patients with mild GORD do well on symptomatic self-care with antacids and/or alginate. In addition, lifestyle changes should be advised to all patients: these improve symptoms and enhance the efficacy of therapy. In the acute treatment of GORD the prokinetic drug cisapride has been shown to be effective in relieving symptoms and healing grade I to II oesophagitis. Cisapride decreases symptomatic and endoscopic relapse in patients with mild GORD. Histamine H2-receptor antagonists are effective in relieving reflux symptoms in about 50% of patients, but with regard to healing, H2-antagonists appear to be mainly effective in grades I and II and not in higher grades of oesophagitis. Maintenance treatment with H2-antagonists is mainly symptomatically effective in patients with mild GORD. Proton pump inhibitors (PPIs) provide significantly higher healing rates of reflux oesophagitis than H2-antagonists, even in the more severe cases of oesophagitis and Barrett's ulcers. PPIs are also effective in patients with oesophagitis refractory to treatment with H2-antagonists. PPIs have become the drugs of first choice in healing of all patients with more severe forms of reflux oesophagitis, and increasingly also for patients with milder forms of oesophagitis, certainly those who fail to respond to other drugs. In maintenance treatment of GORD, PPIs are the most effective drugs, offering the possibility of keeping nearly all patients in remission with adjusted doses. Current patient data of up to 5 years indicate the safety of this strategy for this period, but the exact consequences of strong acid inhibition over a longer period still have to be clarified. At present, all but a few patients with GORD can be managed adequately by medical therapy.
胃食管反流病（GORD）的范围从无食管炎的发作性症状性反流到严重的食管黏膜损伤，如巴雷特化生或消化性狭窄。GORD的多因素发病机制使得该病难以通过药物治愈。GORD是一种具有高复发倾向的慢性病，几乎所有患者都需要长期治疗策略。并非所有患者的治疗目标都是使所有黏膜病变完全愈合。在较轻形式的反流病中，缓解症状是最重要的目标。许多轻度GORD患者通过使用抗酸剂和/或藻酸盐进行症状性自我护理效果良好。此外，应建议所有患者改变生活方式：这有助于改善症状并提高治疗效果。在GORD的急性治疗中，促动力药西沙必利已被证明可有效缓解症状并治愈I至II级食管炎。西沙必利可降低轻度GORD患者的症状性和内镜下复发率。组胺H2受体拮抗剂在约50%的患者中可有效缓解反流症状，但在愈合方面，H2拮抗剂似乎主要对I级和II级食管炎有效，对更高级别的食管炎无效。H2拮抗剂的维持治疗对轻度GORD患者主要是症状性有效。质子泵抑制剂（PPI）比H2拮抗剂能显著提高反流性食管炎的愈合率，即使在食管炎和巴雷特溃疡更严重的病例中也是如此。PPI对H2拮抗剂治疗无效的食管炎患者也有效。PPI已成为所有更严重形式反流性食管炎患者愈合治疗的首选药物，对于较轻形式食管炎的患者，尤其是那些对其他药物无反应的患者，使用也越来越多。在GORD的维持治疗中，PPI是最有效的药物，通过调整剂量几乎可以使所有患者保持缓解状态。目前长达5年的患者数据表明了该策略在此期间的安全性，但长期强力抑制胃酸的确切后果仍有待阐明。目前，除少数GORD患者外，大多数患者可通过药物治疗得到充分管理。
