Marshall R E, Anggiansah A, Manifold D K, Owen W A, Owen W J
Department of Surgery, Guy's Hospital, London, UK.
Gut. 1998 Nov;43(5):603-6. doi: 10.1136/gut.43.5.603.
Both acid and duodenal contents are thought to be responsible for the mucosal damage in Barrett's oesophagus, a condition often treated medically. However, little is known about the effect of omeprazole on duodenogastric reflux (DGR) and duodenogastro-oesophageal reflux (DGOR).
To study the effect of omeprazole 20 mg twice daily on DGR and DGOR, using the technique of ambulatory bilirubin monitoring.
Twenty three patients with Barrett's oesophagus underwent manometry followed by 24 hour oesophageal and gastric pH monitoring. In conjunction with pH monitoring, 11 patients (group 1) underwent oesophageal bilirubin monitoring and 12 patients (group 2) underwent gastric bilirubin monitoring, both before and during treatment with omeprazole 20 mg twice daily.
In both groups there was a significant reduction in oesophageal acid (pH<4) reflux (p<0.005) and a significant increase in the time gastric pH was above 4 (p<0.005). In group 1, median total oesophageal bilirubin exposure was significantly reduced from 28.9% to 2.4% (p<0.005). In group 2, median total gastric bilirubin exposure was significantly reduced from 24.9% to 7.2% (p<0.005).
Treatment of Barrett's oesophagus with omeprazole 20 mg twice daily results in a notable reduction in the exposure of the oesophagus to both acid and duodenal contents. In addition, delivery of duodenal contents to the upper gastric body is reduced.
酸和十二指肠内容物都被认为是导致巴雷特食管黏膜损伤的原因，巴雷特食管通常采用药物治疗。然而，关于奥美拉唑对十二指肠胃反流（DGR）和十二指肠胃食管反流（DGOR）的影响知之甚少。
采用动态胆红素监测技术，研究每日两次服用20mg奥美拉唑对DGR和DGOR的影响。
23例巴雷特食管患者先进行测压，然后进行24小时食管和胃pH监测。在pH监测的同时，11例患者（第1组）在每日两次服用20mg奥美拉唑治疗前和治疗期间进行食管胆红素监测，12例患者（第2组）进行胃胆红素监测。
两组患者食管酸（pH<4）反流均显著减少（p<0.005），胃pH高于4的时间显著增加（p<0.005）。在第1组中，食管总胆红素暴露中位数从28.9%显著降至2.4%（p<0.005）。在第2组中，胃总胆红素暴露中位数从24.9%显著降至7.2%（p<0.005）。
每日两次服用20mg奥美拉唑治疗巴雷特食管可显著减少食管对酸和十二指肠内容物的暴露。此外，十二指肠内容物向胃体上部的输送也减少。
