Durazo F A, Valenzuela J E
Los Angeles County and University of Southern California Medical Center.
Am J Gastroenterol. 1993 Oct;88(10):1657-62.
Decreased lower esophageal sphincter pressure, transient relaxations of the lower esophageal sphincter, and acute increases in intra-abdominal pressure are among the most common pathogenic factors in gastroesophageal reflux. This study examines the effect of metoclopramide on these factors in patients with gastroesophageal reflux disease. Six patients with clinical and endoscopic evidence of esophagitis underwent esophageal manometry and intraesophageal pH monitoring over a 5-h period (1 h basal, and 4 h postprandially). The study was done on three different days: on day 1, after placebo, on day 2, after 10 mg po metoclopramide (order randomized), and on day 3, after metoclopramide 10 mg po quid for 7 days. Metoclopramide given for 1 wk significantly increased the basal lower esophageal sphincter pressure as compared to placebo and a single dose (p < 0.05). It also significantly decreased reflux episodes during the 3rd and 4th hour postprandially when given both as a single dose or after 1 wk of treatment. There was no significant difference in the other parameters measured. Repeated metoclopramide doses decrease reflux episodes in patients with reflux esophagitis by increasing basal lower esophageal sphincter pressure and possibly by accelerating gastric emptying.
食管下括约肌压力降低、食管下括约肌短暂松弛以及腹内压急性升高是胃食管反流最常见的致病因素。本研究探讨甲氧氯普胺对胃食管反流病患者这些因素的影响。6例有食管炎临床及内镜证据的患者在5小时内（基础状态1小时，餐后4小时）接受食管测压和食管内pH监测。研究在三个不同日期进行：第1天，服用安慰剂后；第2天，口服10毫克甲氧氯普胺后（顺序随机）；第3天，口服10毫克甲氧氯普胺每日一剂，共7天后。与安慰剂和单剂量相比，服用1周的甲氧氯普胺显著增加了基础食管下括约肌压力（p<0.05）。单剂量或治疗1周后，它还显著减少了餐后第3小时和第4小时的反流发作次数。所测量的其他参数无显著差异。重复给予甲氧氯普胺剂量可通过增加基础食管下括约肌压力并可能通过加速胃排空来减少反流性食管炎患者的反流发作次数。
