促动力药物在胃食管反流病治疗中的研究进展  

Advances in roles of prokinetic agents in the treatment of gastroesophageal reflux disease

作　　者：朱琦[1] 刘文忠[1] 

机构地区：[1]上海交通大学医学院附属仁济医院消化科上海市消化疾病研究所,上海市200001

出　　处：《世界华人消化杂志》2008年第7期737-745,共9页World Chinese Journal of Digestology

摘　　要：胃食管反流病(gastroesophageal reflux disease,GERD)是由胃内容物反流引起不适症状和(或)并发症的一种疾病.GERD的发病机制包括食管下括约肌(lower esophageal sphincter,LES)功能失调,食管对反流物廓清能力下降,胃排空延迟以及食管黏膜对胃酸的抵抗力异常.因此,恢复胃动力、增强LES收缩以及食管运动的促动力药物常被用于治疗GERD,包括甲氧氯普胺、多潘立酮、西沙必利及莫沙必利等药物.目前认为,对于治疗轻度GERD促动力药物与H2受体阻滞剂具有相同的疗效,而在治疗重症GERD时促动力药物和抑酸药物联合治疗比单药治疗更有效.本文就将促动力药物在GERD治疗方案中作用和地位的研究进展作一综述。Gastroesophageal reflux disease （GERD） is characterized by the reflux of gastric content into esophagus with or without histological changes. Pathogenesis of GERD is lower esophageal sphincter （LES） dysfunction, abnormal clearing capacity of refluxed materials, delayed gastric emptying and abnormal resistance of esophageal mucosa to gastric acid, but the primary upper gastrointestinal motility dysfunction is regarded as the most important factor in general. Therefore, prokinetic agents which can restore gastric motility with increasing of LES and esophageal motility have been developed and used frequently in the treatment of GERD. There are several prokinetic agents such as metoclopramide, domperidone, cisapride and mosapride that facilitate acetylcholine release from the enteric cholinergic neurons through a selective 5-HT4 receptor agonistic action. It is considered that prokinetic agents have the same effect as H2 blocker in the treatment of patients with mild GERD. Additionally, it was reported that a combination therapy with prokineticagents and proton pump inhibitors （PPI） or H2 receptor antagonists （H2RAs） is more effective than monotherapy in patients with severe GERD. This article reviews the recent advances in the role of prokinetic agents in the treatment of gastroesophageal reflux disease.

关 键 词：促动力药物 胃食管反流病 治疗 莫沙必利 

分 类 号：R571[医药卫生—消化系统]