Strauss R S, Calenda K A, Dayal Y, Mobassaleh M
Division of Pediatric Gastroenterology and Nutrition, The Floating Hospital for Children at New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA.
Dig Dis Sci. 1999 Jan;44(1):134-9. doi: 10.1023/a:1026666503642.
Many children with esophagitis demonstrate histological changes without gross evidence of esophagitis by esophagoscopy. The effect of omeprazole on the histological healing of esophagitis in children is unknown. Therefore, the aim of this study was to determine the effect of omeprazole on refractory histological esophagitis in pediatric patients. Eighteen patients with histological evidence of esophagitis and recurrent symptoms despite therapy with H2-receptor antagonists and prokinetic agents were prospectively treated with omeprazole. Dosing was adjusted by monitoring intragastric pH, and esophagoscopy was repeated after 8-12 weeks of omeprazole treatment. Two patients did not complete the study due to either worsening symptoms or hypergastrinemia. Of the remaining patients, 76% were asymptomatic with omeprazole treatment and 24% reported improvement in their symptoms. Approximately 40% demonstrated complete histological healing of their esophagitis. Three patients (17%) had persistent elevations in serum gastrin levels while on omeprazole treatment, which was associated with both younger patient age and higher omeprazole dosing; however, all elevated gastrin levels returned to normal after discontinuation of the medication. All patients had recurrence of their symptoms after completing a course of omeprazole, even patients with complete histological healing. Omeprazole is efficacious in treating children with esophagitis refractory to H2-receptor antagonist and prokinetic agents. However, none of the patients were able to discontinue acid suppressive therapy even after documented healing of their esophagitis.
许多患有食管炎的儿童虽经食管镜检查未发现食管炎的肉眼可见证据，但却呈现出组织学变化。奥美拉唑对儿童食管炎组织学愈合的影响尚不清楚。因此，本研究的目的是确定奥美拉唑对儿科患者难治性组织学食管炎的影响。18例有食管炎组织学证据且尽管接受了H2受体拮抗剂和促动力剂治疗仍有复发症状的患者，前瞻性地接受了奥美拉唑治疗。通过监测胃内pH值调整剂量，在奥美拉唑治疗8 - 12周后重复进行食管镜检查。2例患者因症状恶化或高胃泌素血症未完成研究。在其余患者中，76%在接受奥美拉唑治疗后无症状，24%报告症状有所改善。约40%的患者食管炎组织学完全愈合。3例患者（17%）在接受奥美拉唑治疗期间血清胃泌素水平持续升高，这与患者年龄较小和奥美拉唑剂量较高有关；然而，停药后所有升高的胃泌素水平均恢复正常。所有患者在完成一个疗程的奥美拉唑治疗后症状均复发，即使是食管炎组织学完全愈合的患者。奥美拉唑对H2受体拮抗剂和促动力剂难治性食管炎患儿有效。然而，即使食管炎经记录已愈合，也没有患者能够停止抑酸治疗。
