Hotz J, Plein K, Bunke R
Klinik für Gastroenterologie, Allgemeines Krankenhaus Celle.
Med Klin (Munich). 1994 Feb 15;89(2):73-80, 107.
It is generally accepted that functional dyspepsia is caused by heterogeneous pathogenetic factors. From the clinical point of view acid-related symptoms as heartburn, acid regurgitation and epigastric pain (acid-type) can be separated from general dyspeptic symptoms as predominant fullness, nausea/vomiting (dysmotility-type).
In the present study, the influence of a four-week-treatment with ranitidine (twice 150/d, n = 346) in comparison with an antacid (40 mmol/d, n = 340) on the severity and course of symptoms in patients suffering from an acid-related functional dyspepsia was investigated.
With ranitidine, acid-related as well as general dyspeptic symptoms disappeared in a significantly higher percentage after two and four weeks compared with antacid. Complete disappearance of symptoms was documented with ranitidine after two weeks in 37% and after four weeks in 66% compared with antacid in 13% and 30% respectively (p < 0.005). Patients with severe symptoms, history of ulcer and long-term dyspepsia and slight endoscopic changes in the upper gastrointestinal tract showed a significant faster and more distinct response. Both kinds of treatment were well tolerated.
It is concluded that in acid-related functional dyspepsia ranitidine is superior to antacid in relieving symptoms. Therefore, a probative treatment with ranitidine up to four weeks is recommended as a practical therapeutic alternative in this syndrome.
一般认为功能性消化不良由多种致病因素引起。从临床角度看,烧心、反酸和上腹痛等与酸相关的症状(酸型)可与以饱胀感、恶心/呕吐为主的一般消化不良症状(动力障碍型)区分开来。
在本研究中,调查了雷尼替丁(每日两次,每次150mg,n = 346)与抗酸剂(每日40mmol,n = 340)进行四周治疗对酸相关性功能性消化不良患者症状严重程度及病程的影响。
与抗酸剂相比,使用雷尼替丁治疗两周和四周后,酸相关症状以及一般消化不良症状消失的百分比显著更高。雷尼替丁治疗两周后症状完全消失的比例为37%,四周后为66%,而抗酸剂治疗两周和四周后症状完全消失的比例分别为13%和30%(p < 0.005)。症状严重、有溃疡病史、长期消化不良且上消化道内镜检查有轻微改变的患者反应明显更快、更显著。两种治疗耐受性均良好。
得出的结论是,在酸相关性功能性消化不良中,雷尼替丁在缓解症状方面优于抗酸剂。因此,建议使用雷尼替丁进行四周的验证性治疗,作为该综合征的一种实用治疗选择。