Barbier J P, Haccoun P, Bergmann J F, Arnould B, Hamelin B
Service de Gastroentérologie, hôpital Laënnec, Paris.
Ann Gastroenterol Hepatol (Paris). 1993 Jun-Sep;29(4):213-8.
Four hundred and thirty patients with grade 2 or 3 esophagitis were treated after 2/1 randomization for 8 weeks with omeprazole 20 mg (n = 294) or ranitidine 150 mg bid (n = 136). Apart from treatment, 8 epidemiological factors (gender, age, occupation, obesity, smoking, alcohol, NSAID, and coffee or tea consumption), 5 clinical factors (day/night pain distribution, burning score, severity of regurgitation and of dysphagia, number of painful episodes requiring prescription of an antisecretory agent during the previous year, and onset of symptoms before age 30) and 3 endoscopic factors (grade and upward extension of esophagitis, and existence of hiatal hernia > or = 5 cm) were analysed. The influence of these factors on healing at 8 weeks and on changes in symptoms was evaluated by multivariate analysis. 92.1% of patients enrolled were analyzed. In comparison with ranitidine, omeprazole increased the percentage of healed patients (93% v. 67.5%, p < 0.001) and the rapidity of disappearance of symptoms (5 days v. 7 days, p < 0.001). Independent good prognostic factors associated with healing rate were treatment with omeprazole (p < 0.001) and grade 2 esophagitis (p < 0.001) while those associated with the disappearance of symptoms were a low burning score (p = 0.001), advanced age (p = 0.004), treatment with omeprazole (p = 0.005), the absence of any occupation (p = 0.01) and male gender (p = 0.017). The results of this study show that, apart from treatment, endoscopic factors are predictive of the healing of reflux esophagitis treated by antisecretory agents while clinical factors are more important with regard to the disappearance of symptoms.
430例2级或3级食管炎患者按2∶1随机分组，分别接受8周的奥美拉唑20毫克治疗（n = 294）或雷尼替丁150毫克每日两次治疗（n = 136）。除治疗外，分析了8个流行病学因素（性别、年龄、职业、肥胖、吸烟、饮酒、非甾体抗炎药使用情况以及咖啡或茶的摄入量）、5个临床因素（昼夜疼痛分布、烧灼感评分、反流和吞咽困难的严重程度、前一年需要使用抗分泌剂处方的疼痛发作次数以及30岁之前症状的发作情况）和3个内镜因素（食管炎的分级和向上扩展情况以及是否存在≥5厘米的食管裂孔疝）。通过多变量分析评估这些因素对8周愈合情况和症状变化的影响。对92.1%的入组患者进行了分析。与雷尼替丁相比，奥美拉唑提高了愈合患者的比例（93%对67.5%，p < 0.001）以及症状消失的速度（5天对7天，p < 0.001）。与愈合率相关的独立良好预后因素是使用奥美拉唑治疗（p < 0.001）和2级食管炎（p < 0.001），而与症状消失相关的因素是低烧灼感评分（p = 0.001）、高龄（p = 0.004）、使用奥美拉唑治疗（p = 0.005）、无任何职业（p = 0.01）和男性（p = 0.017）。本研究结果表明，除治疗外，内镜因素可预测抗分泌剂治疗的反流性食管炎的愈合情况，而临床因素在症状消失方面更为重要。
