Chiba N
Department of Medicine, McMaster University, Hamilton, Ontario.
Can J Gastroenterol. 1997 Sep;11 Suppl B:66B-73B.
The aim of this paper is to present a systematic overview of the efficacy of the proton pump inhibitors (PPI), omeprazole and the newer lansoprazole, in the healing and maintenance of erosive or worse (grade II to IV) esophagitis. At the time of the 1996 gastroesophageal reflux disease (GERD) consensus meeting, a third PPI, pantoprazole, was not yet available in Canada and was, therefore, not discussed. The present review is therefore restricted to patients with more severe disease than that of the average patient who presents to the family physician with symptoms of mild GERD. In these patients with endoscopic evidence of damaged esophageal mucosa, both proton pump inhibitors were highly effective and safe in acute healing of erosive esophagitis and were significantly better than H2 receptor antagonists, healing faster and much more completely, with shorter durations of treatment. Suggested initial doses were omeprazole 20 mg once daily and lansoprazole 30 mg once daily, which were consistent with the manufacturer's recommendations. Once patients with this degree of esophagitis have their mucosal lesions healed, they almost inevitably have recurrence of esophagitis (80% at one year) unless some form of maintenance therapy is continued. Unfortunately, for these patients with healed erosive or ulcerative esophagitis, H2 receptor antagonists appear to be no better than placebo, and a PPI is the only class of drug able to minimize relapse significantly.
本文旨在系统综述质子泵抑制剂（PPI）奥美拉唑和较新的兰索拉唑在糜烂性食管炎或更严重（II至IV级）食管炎的愈合和维持治疗中的疗效。在1996年胃食管反流病（GERD）共识会议召开时，第三种PPI泮托拉唑在加拿大尚未上市，因此未被讨论。因此，本综述仅限于病情比因轻度GERD症状就诊于家庭医生的普通患者更严重的患者。在这些有食管黏膜损伤内镜证据的患者中，两种质子泵抑制剂在糜烂性食管炎的急性愈合中均高度有效且安全，并且明显优于H2受体拮抗剂，愈合更快、更彻底，治疗时间更短。建议的初始剂量为奥美拉唑每日一次20毫克和兰索拉唑每日一次30毫克，这与制造商的建议一致。一旦患有这种程度食管炎的患者黏膜病变愈合，除非继续某种形式的维持治疗，否则他们几乎不可避免地会出现食管炎复发（一年复发率为80%）。不幸的是，对于这些糜烂性或溃疡性食管炎已愈合的患者，H2受体拮抗剂似乎并不比安慰剂更好，而PPI是唯一一类能够显著减少复发的药物。
