Schindlbeck N E, Klauser A G, Voderholzer W A, Müller-Lissner S A
Department of Gastroenterology, Klinikum Innenstadt, University of Munich, Germany.
Arch Intern Med. 1995 Sep 11;155(16):1808-12.
In the absence of highly specific symptoms and without esophageal erosions, long-term pH monitoring is necessary for diagnosing gastroesophageal reflux disease. This method, however, is not generally available.
To determine whether gastroesophageal reflux disease can be diagnosed empirically by acid suppression in patients with normal results of endoscopy.
We studied 33 consecutive outpatients with pathologic findings on pH monitoring who had symptoms compatible with gastroesophageal reflux disease and normal results of esophagogastroduodenoscopy, particularly a normal appearance of the esophageal mucosa. The severity of symptoms was graded on a visual analog scale from 1 to 10 by the patient. The patients were treated for at least 7 days with either ranitidine, 150 mg twice daily (patients 1 through 10), omeprazole, 40 mg/d (patients 11 through 21), or omeprazole, 40 mg twice daily (patients 22 through 33). A reassessment of symptoms and second pH monitoring were performed during the last day of treatment.
Omeprazole, 40 mg/d, significantly reduced the severity of symptoms from 7.1 (range, 4 to 9) to 3.7 (0 to 8) and the reflux measure mean acidity from 0.98 mmol/L (0.21 to 76 mmol/L) to 0.02 mmol/L (0 to 0.47 mmol/L). Omeprazole, 40 mg twice daily, significantly reduced the severity of symptoms from 6.8 (3 to 10) to 0.6 (0 to 2) and the mean acidity from 0.38 mmol/L (0.13 to 8.5 mmol/L) to 0.01 mmol/L (0 to 0.14 mmol/L). Both doses of omeprazole were superior to ranitidine, 150 mg twice daily. When a 75% reduction of symptoms was defined as positive, the "omeprazole test" with 40 mg twice daily had a sensitivity of 83.3%, whereas the sensitivity with 40 mg/d was only 27.2%.
In practice, the diagnosis of gastroesophageal reflux disease can be ruled out if symptoms do not improve with a limited course of high-dose proton pump inhibitors.
在缺乏高度特异性症状且无食管糜烂的情况下，长期pH监测对于诊断胃食管反流病是必要的。然而，这种方法并非普遍可用。
确定在内镜检查结果正常的患者中，是否可通过抑酸试验经验性诊断胃食管反流病。
我们研究了33例连续门诊患者，这些患者pH监测有病理结果，有与胃食管反流病相符的症状且食管胃十二指肠镜检查结果正常，尤其是食管黏膜外观正常。患者根据视觉模拟量表将症状严重程度从1到10进行评分。患者接受雷尼替丁（每日2次，每次150 mg，第1至10例患者）、奥美拉唑（每日40 mg，第11至21例患者）或奥美拉唑（每日2次，每次40 mg，第22至33例患者）治疗至少7天。在治疗的最后一天对症状进行重新评估并进行第二次pH监测。
每日40 mg奥美拉唑可使症状严重程度从7.1（范围4至9）显著降低至3.7（0至8），反流测量平均酸度从0.98 mmol/L（0.21至76 mmol/L）降至0.02 mmol/L（0至0.47 mmol/L）。每日2次，每次40 mg奥美拉唑可使症状严重程度从6.8（3至10）显著降低至0.6（0至2），平均酸度从0.38 mmol/L（0.13至8.5 mmol/L）降至0.01 mmol/L（0至0.14 mmol/L）。两种剂量的奥美拉唑均优于每日2次，每次150 mg的雷尼替丁。当将症状减轻75%定义为阳性时，每日2次，每次40 mg的“奥美拉唑试验”敏感性为83.3%，而每日40 mg时敏感性仅为27.2%。
在实际应用中，如果在有限疗程的高剂量质子泵抑制剂治疗后症状未改善，则可排除胃食管反流病的诊断。
