Marrero J M, de Caestecker J S, Maxwell J D
Division of Biochemical Medicine, St George's Hospital Medical School, London.
Gut. 1994 Apr;35(4):447-50. doi: 10.1136/gut.35.4.447.
Gastric acid suppression could improve heartburn by healing oesophagitis or by reduction of oesophageal sensitivity to acid. To independently assess changes in oesophageal sensitivity, it would be necessary to study patients with reflux disease but no oesophagitis. The aim of this study was to investigate the effect of acid suppression on oesophageal sensitivity and to assess the time course of any measured effect. Twenty seven patients were recruited, of whom 25 completed the study (14 men and 11 women, mean (SD) age 50 (15) years). All had classic symptoms of gastro-oesophageal reflux but normal results of upper gastrointestinal endoscopy and oesophageal mucosal histological tests. Each had abnormal 24 hour pH studies and a positive acid perfusion tests. Subjects were assigned double blind to placebo (n = 11) or famotidine 40 mg twice daily (n = 14) for four weeks. Acid perfusion tests were carried out at 0, 4, 5, and 8 weeks and time to heartburn recorded. Time to heartburn (mean (SEM)) was 124 (78) seconds in the famotidine and 187 (154) in the placebo group at week 0 (NS). Compared with baseline, significant increases in time to heartburn was found with famotidine at weeks 4 (383 (102), p < 0.01) and 5 (344 (92), p < 0.01) but not week 8 (336 (90) seconds). No significant effects were found with placebo (219 (41), 146 (23), and 144 (25) seconds for weeks 4, 5, and 8). Heartburn symptom score decreased significantly with famotidine (mean scores 3.6, 1.9, 2.1, and 2.6 at weeks 0, 4, 5, and 8 (p=0.001)) and showed a significant negative correlation with time to heartburn (r(s)=-0.60; p<0.0001). It is concluded that oesophageal sensitivity to acid is reduced by famotidine independent of and effect on oesophagitis; the effect wanes one to four weeks after the end of treatment and correlates with change in heartburn score.
胃酸抑制可通过治愈食管炎或降低食管对酸的敏感性来改善烧心症状。为独立评估食管敏感性的变化，有必要研究患有反流性疾病但无食管炎的患者。本研究的目的是调查胃酸抑制对食管敏感性的影响，并评估任何测量效应的时间进程。招募了27名患者，其中25名完成了研究（14名男性和11名女性，平均（标准差）年龄50（15）岁）。所有患者均有胃食管反流的典型症状，但上消化道内镜检查和食管黏膜组织学检查结果正常。每位患者24小时pH监测结果均异常，酸灌注试验呈阳性。受试者被双盲分配到安慰剂组（n = 11）或法莫替丁组（每日两次，每次40 mg，n = 14），为期四周。在第0、4、5和8周进行酸灌注试验，并记录出现烧心的时间。在第0周时，法莫替丁组出现烧心的时间（平均（标准误））为124（78）秒，安慰剂组为187（154）秒（无显著性差异）。与基线相比，法莫替丁在第4周（383（102），p < 0.01）和第5周（344（92），p < 0.01）时出现烧心的时间显著增加，但在第8周（336（90）秒）时未增加。安慰剂组在第4、5和8周时未发现显著效应（分别为219（41）、146（23）和144（25）秒）。法莫替丁使烧心症状评分显著降低（第0、4、5和8周的平均评分分别为3.6、1.9、2.1和2.6（p = 0.001）），且与出现烧心的时间呈显著负相关（r(s)= -0.60；p < 0.0001）。结论是，法莫替丁可降低食管对酸的敏感性，这与对食管炎的影响无关；该效应在治疗结束后1至4周减弱，并与烧心评分的变化相关。
