Wittmann T, Rosztóczy A, Fehér A, Jármay K, Oláh T, Szendrényi V, Kiss I
I. Belgyógyászati Klinika, Szent-Györgyi Albert Orvostudományi Egyetem, Szeged.
Orv Hetil. 1998 May 3;139(18):1077-81.
One year follow up(1.5, 3, 6, 12 months) study was established to examine the role of several classes of drugs in the treatment of reflux disease in 40 patients on the basis of objective control parameters (pH-metry, endoscopy, histology). The therapy was initiated, respectively, the different stage of severity (Savary-Miller): in stage 0 sucralfate + domperidone, in stage I and II: ranitidine + domperidone and in stage III-IV omeprazole was introduced. Our results proved that sucralfate + domperidone is curative on reflux oesophagitis in stage 0 cases. In stage I sucralfate and domperidone were effective in 3 of 9 cases, ranitidine + domperidone was optimal in 5 of 9, and omeprazole was required in 1 of 9 patients. In stage II, ranitidine + domperidone was effective only in 4 of 11 patients, and the initial therapy was modified to omeprazole in 7 of 11 patients to find the optimal drug in this stage. In stage III and IV only omeprazole showed curative effect and the doses required were 20 mg in 8 of 13 and 40 mg in 5 of 13 patients. The complaints improved in 34 of 40 patients after 6 weeks treatment, while histological healing of reflux oesophagitis was observed in 12 of 40 cases. After 3 months the endoscopic healing rate was 28/40, but histological healing could be reached after 6 months of optimal treatment in 30 of 40 cases. We can conclude, that the optimal drug selection may result a rapid improvement of complaints, but endoscopic and histological regeneration of the oesophageal mucosa is more graduated with time. The healing process of the reflux oesophagitis requires 3 months. Proton pump inhibitor drugs have an enhanced role in the treatment of gastrooesophageal reflux disease, and our results proved that the efficient and safety treatment of mild form (stage II) of disease requires the administration of proton pump inhibitors.
开展了一项为期一年的随访研究（1.5、3、6、12个月），以40例患者为对象，基于客观控制参数（pH值测定、内镜检查、组织学检查）研究几类药物在反流性疾病治疗中的作用。根据不同的严重程度阶段（Savary-Miller分级）分别开始治疗：0期使用硫糖铝+多潘立酮，I期和II期使用雷尼替丁+多潘立酮，III-IV期引入奥美拉唑。我们的结果证明，硫糖铝+多潘立酮对0期反流性食管炎具有治愈作用。在I期，硫糖铝和多潘立酮在9例中有3例有效，雷尼替丁+多潘立酮在9例中有5例效果最佳，9例中有1例需要使用奥美拉唑。在II期，雷尼替丁+多潘立酮仅在11例中的4例有效，11例中有7例将初始治疗改为奥美拉唑，以在该阶段找到最佳药物。在III期和IV期，只有奥美拉唑显示出治愈效果，13例中有8例所需剂量为20mg，13例中有5例所需剂量为40mg。40例患者中有34例在治疗6周后症状改善，40例中有12例观察到反流性食管炎的组织学愈合。3个月后内镜愈合率为28/40，但在40例中有30例在最佳治疗6个月后可实现组织学愈合。我们可以得出结论，最佳药物选择可能会使症状迅速改善，但食管黏膜的内镜和组织学再生随时间进展更为缓慢。反流性食管炎的愈合过程需要3个月。质子泵抑制剂药物在胃食管反流病的治疗中发挥着更大的作用，我们的结果证明，对疾病轻度形式（II期）进行有效且安全的治疗需要使用质子泵抑制剂。
