Janczewska I, Sagar M, Sjöstedt S, Hammarlund B, Iwarzon M, Seensalu R
Dept. of Gastroenterology and Hepatology, Huddinge University Hospital, Sweden.
Scand J Gastroenterol. 1998 Dec;33(12):1239-43. doi: 10.1080/00365529850172304.
Lansoprazole (LAN) and omeprazole (OME) heal esophagitis effectively and to similar extents, but LAN has a faster effect on the relief of symptoms of gastroesophageal reflux. However, no strict comparison of the two proton pump inhibitors' effect on acid reflux and gastric acidity has been published. The aim of this study was to compare the effects of LAN and OME on gastroesophageal reflux with simultaneous measurements of gastric acidity in patients with established gastroesophageal reflux disease (GERD) and esophagitis.
Fourteen patients with endoscopically verified erosive esophagitis and with a pretreatment esophageal 24-h pH measurement showing acid reflux to the esophagus participated in the study. This was a double-blind, randomized study with crossover design. Before (day 0) and on the last day (day 5) of each treatment period with encapsulated 30 mg LAN or 20 mg OME daily, 24-h intraesophageal and intragastric acidity were measured with antimony electrodes connected to an ambulatory pH recording system.
Ten of 14 patients completed the study. There were no differences in intragastric or intraesophageal acidity or the number of reflux episodes on day 0 between the two treatments. Both LAN and OME treatments increased the median and nocturnal intragastric pH and decreased the 24-h area under the time curve for intragastric acidity significantly and to about the same extent (79% and 69% acid inhibition by LAN and OME, respectively) (NS). However, the percentage of time with pH below 4 in the esophagus was significantly less during LAN treatment (1.92% +/- 2.29; mean +/- standard deviation) than during OME treatment (4.76% +/- 2.88%) on day 5 (P = 0.002). There were also significantly fewer reflux episodes >5 min during treatment with LAN (1.00 +/- 1.33) than with OME (2.90 +/- 2.42) at the end of the treatment period (P = 0.031).
In this study lansoprazole and omeprazole had a comparable effect on gastric acidity in patients with established GERD with esophagitis. However, 30 mg lansoprazole daily reduced the acidity in the oesophagus and the number of refluxes more effectively than 20 mg omeprazole daily. This might indicate that proton pump inhibitors affect the esophageal clearance and/or influence the lower esophageal sphincter differently.
兰索拉唑（LAN）和奥美拉唑（OME）能有效治愈食管炎，且程度相似，但兰索拉唑对缓解胃食管反流症状起效更快。然而，尚未有关于这两种质子泵抑制剂对胃酸反流和胃酸度影响的严格比较发表。本研究的目的是比较兰索拉唑和奥美拉唑对胃食管反流的影响，并同时测量已确诊胃食管反流病（GERD）和食管炎患者的胃酸度。
14例经内镜证实有糜烂性食管炎且治疗前食管24小时pH测量显示有食管酸反流的患者参与了本研究。这是一项采用交叉设计的双盲随机研究。在每天服用30毫克胶囊装兰索拉唑或20毫克奥美拉唑的每个治疗期开始前（第0天）和最后一天（第5天），用连接到动态pH记录系统的锑电极测量24小时食管内和胃内酸度。
14例患者中有10例完成了研究。两种治疗在第0天的胃内或食管内酸度或反流发作次数上无差异。兰索拉唑和奥美拉唑治疗均显著提高了胃内pH中位数和夜间pH值，并使胃内酸度的24小时时间曲线下面积降低，且降低程度大致相同（兰索拉唑和奥美拉唑的抑酸率分别为79%和69%）（无显著性差异）。然而，在第5天兰索拉唑治疗期间食管内pH值低于4的时间百分比（1.92%±2.29；平均值±标准差）显著低于奥美拉唑治疗期间（4.76%±2.88%）（P = 0.002）。在治疗期末，兰索拉唑治疗期间反流发作>5分钟的次数（1.00±1.33）也显著少于奥美拉唑治疗期间（2.90±2.42）（P = 0.031）。
在本研究中，兰索拉唑和奥美拉唑对已确诊GERD伴食管炎患者的胃酸度有相当的影响。然而，每日30毫克兰索拉唑比每日20毫克奥美拉唑更有效地降低了食管酸度和反流次数。这可能表明质子泵抑制剂对食管清除和/或对食管下括约肌的影响不同。
