Hirschowitz B I, Mohnen J, Shaw S
Department of Medicine, University of Alabama at Birmingham 35294, USA.
Aliment Pharmacol Ther. 1996 Aug;10(4):497-506. doi: 10.1046/j.1365-2036.1996.11153000.x.
About 10% of patients with duodenal ulcers have marked gastric acid hypersecretion with basal acid output (BAO) of more than 15 mmol/h, which is in the range found in Zollinger-Ellison syndrome.
We report long-term, up to 4 years, prospective treatment using lansoprazole in nine male patients with duodenal ulcers and a BAO of more than 15 mmol/h whose results are compared with those in 10 male Zollinger-Ellison syndrome patients with intact stomachs reported in detail in an accompanying paper.
All 19 subjects, except one Zollinger-Ellison syndrome patient who had gastric and oesophageal ulcers, had a history of duodenal ulcers; 22% of those with gastric acid hypersecretion had oesophagitis compared with 60% of those with Zollinger-Ellison syndrome. Each subject had the dose of lansoprazole adjusted to give a BAO of less than 5 mmol/h. At 3-month intervals to 1 year, and then at 6-monthly intervals, basal and pentagastrin stimulated secretions were studied, in addition to gastroscopy with biopsy for gastric mucosal morphology. Basal and maximal acid and pepsin secretions were not different between gastric acid hypersecretion and Zollinger-Ellison syndrome patients before treatment. During treatment, BAO was reduced by over 90% to less than 2 mmol/h, while peak acid output was reduced by 70% in those with gastric acid hypersecretion and 90% in Zollinger-Ellison syndrome patients. Four gastric acid hypersecretion patients had relapses during treatment, three times in one patient and twice in another patient, but all responded to continued treatment with lansoprazole. Of the seven ulcer-related relapses in the gastric acid hypersecretion patients, four occurred with a BAO of less than 2 mmol/h and three with a BAO of 7.1-7.3 mmol/h; five of the seven relapses occurred in the absence of Helicobacter pylori. Lansoprazole remained effective at an average dose of approximately 70 mg/day, without causing any side-effects.
Lansoprazole is apparently safe and effective for treating hypersecretion, whether due to hypergastrinaemia (Zollinger-Ellison syndrome) or not (non-Zollinger-Ellison syndrome hypersecretors).
约10%的十二指肠溃疡患者胃酸分泌明显过多，基础酸排量（BAO）超过15 mmol/h，这一范围见于佐林格 - 埃利森综合征。
我们报告了9例男性十二指肠溃疡且BAO超过15 mmol/h患者使用兰索拉唑进行长达4年的前瞻性治疗，其结果与另一篇论文中详细报道的10例胃完整的男性佐林格 - 埃利森综合征患者的结果进行比较。
19名受试者中，除1例患有胃溃疡和食管炎的佐林格 - 埃利森综合征患者外，均有十二指肠溃疡病史；胃酸分泌过多者中22%患有食管炎，而佐林格 - 埃利森综合征患者中这一比例为60%。为使每位受试者的BAO低于5 mmol/h，调整兰索拉唑剂量。在1年以内每3个月，之后每6个月，除了进行胃镜检查及胃黏膜形态活检外，还研究基础胃酸分泌及五肽胃泌素刺激的胃酸分泌。治疗前，胃酸分泌过多患者与佐林格 - 埃利森综合征患者的基础胃酸分泌、最大胃酸分泌及胃蛋白酶分泌无差异。治疗期间，BAO降低超过90%，降至2 mmol/h以下，而胃酸分泌过多患者的高峰胃酸排量降低70%，佐林格 - 埃利森综合征患者降低90%。4例胃酸分泌过多患者在治疗期间复发，1例复发3次，另1例复发2次，但所有患者继续使用兰索拉唑治疗均有效。在胃酸分泌过多患者的7次溃疡相关复发中，4次发生在BAO低于2 mmol/h时，3次发生在BAO为7.1 - 7.3 mmol/h时；7次复发中有5次发生在无幽门螺杆菌感染的情况下。兰索拉唑平均每日剂量约70 mg时仍有效，且未引起任何副作用。
兰索拉唑治疗胃酸分泌过多显然是安全有效的，无论是否由高胃泌素血症（佐林格 - 埃利森综合征）引起（非佐林格 - 埃利森综合征胃酸分泌过多者）。
