胃食管反流病维持治疗3年前瞻性随访  

A prospective follow-up study: 3-year maintenance treatment in patients with gastroesophageal reflux disease

作　　者：牛春燕[1] 吴方雄 高保华[1] 周永莉[1] 闫蓉[1] 单婕[2] 张婷[2] 罗金燕[3] 

机构地区：[1]西安医学院附属医院消化内科,陕西西安710077 [2]西安医学院附属医院内镜诊疗科,陕西西安710077 [3]西安交通大学医学院第二附属医院消化内科

出　　处：《胃肠病学和肝病学杂志》2013年第6期560-563,共4页Chinese Journal of Gastroenterology and Hepatology

基　　金：陕西省教育厅科研基金(09JK710)

摘　　要：目的探讨3年维持治疗对胃食管反流病(GERD)的疗效,以及GERD三个亚型之间的关系。方法对非糜烂性反流病(NERD)、糜烂性食管炎(EE)、Barrett’s食管(BE)给予质子泵抑制剂+伊托必利维持治疗,并进行3年前瞻性随访,以胃食管反流病问卷(GerdQ)评分及内镜检查结果评估患者的生活质量(quality of life,QOL)及食管黏膜愈合情况。结果 8周标准初始治疗及1年减量及按需维持治疗后,NERD及EE患者的GerdQ评分均较治疗前显著下降(P<0.05);1年、2年、3年按需治疗食管黏膜愈合率分别为92%、93%及95%(与8周后比较,P均<0.05,2年、3年与1年后比较差异无显著性);5例NERD(15.6%)转化为EE(LA-A/B),4例(23.5%)EE转化为NERD。结论减量及按需维持治疗均为GERD患者长期治疗的有效策略,可促使患者生活质量的持续改善及黏膜愈合,就依从性而言按需治疗更有优势;少数NERD与较轻级别的EE(LA-A/B)可相互转化。Objective To investigate the efficacy of long-term maintenance therapy on gastroesophageal reflux dis ease （GERD） , as well as mutual transformation among three types of GERD. Methods Maintenance treatment therapy including proton pump inhibitor （PPI） combined with itopride was administered to patients with non-erosive reflux dis ease （ NERD）, erosive esophagitis （EE） and Barrett＇ s esophagus （BE） respectively, after 3 years of prospective fol- low-up, gastroesophageal reflux disease questionnaire （GerdQ） and endoscopy inspecting were used to assess quality of life （QOL） and mucosal healing of them. Results After 8-week and 1-year maintenance treatment, GerdQ scores of both NERD and EE patients descended than those of pretreatment （P 〈 0.05） ; esophageal mucosal healing rates of EE patients after 1-year, 2-year and 3-year on-demand maintenance treatment were 92% , 93% and 95% respectively （compared with that after 8-week treatment, both P 〈 0.05） ; five of NERD （ 15.6% ） patients developed EE, four of EE （23.5%） patients converted to NERD. Conclusion Both of reduction and on-demand maintenance treatment are effective therapeutic strategies and associated with improved QOL for GERD patients in clinical practice, while on-de mand treatment may has advantage when considering cost-effectiveness as well as compliance ; a small number of recipro cal transformations might occur between NERD and low grade of EE.

关 键 词：胃食管反流病 亚型 维持治疗 3年前瞻性随访 生活质量 

分 类 号：R57[医药卫生—消化系统]