一例初診胃食管反流性疾病患者的循證治療_《中國循證醫學雜志》

作者：

季夢遙 ,  董衛國 , 呂曉光 , 吳娜 , 彭秀蘭

武漢大學人民醫院消化內科（武漢?430060）;

關鍵詞：

胃食管反流性疾病質子泵抑制劑幽門螺桿菌感染抗幽門螺桿菌感染治療循證治療

DOI：

10.7507/1672-2531.20110081

視頻：

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目的　借助循證醫學方法為1例初診胃食管反流性疾病患者確定治療方案。
方法　在充分評估患者情況后，按照PICO原則提出臨床問題并轉化，計算機檢索Cochrane圖書館（1990～ 2010）、PubMed（1990～2010）、Embase（1990～2010），收集相關高質量證據進行評價，并結合醫生經驗及患者愿望制定治療方案。
結果　共納入RCT 17篇，Meta分析/系統評價10篇。結果顯示，選用質子泵抑制劑（PPI）治療的效果優于H2受體拮抗劑，同時應加用促胃動力藥。長期使用PPI時伴有幽門螺旋桿菌（HP）感染者需進行HP根除治療。若需手術治療，腹腔鏡下胃底折疊術治療效果較佳。根據以上證據并結合患者意愿，對該例患者采用一般性治療結合埃索美拉唑伴西沙比利治療；又因長期維持治療過程中患者存在HP感染，故同時進行抗HP藥物治療。治療6個月后，患者胃食管反流相關癥狀得到明顯緩解。
結論　PPI加用促胃動力藥，以及在長期PPI治療中如存在HP感染時聯合HP根除治療，可有效提高療效和患者生活質量，但遠期效果仍需進一步觀察。

引用本文： 季夢遙,董衛國,呂曉光,吳娜,彭秀蘭. 一例初診胃食管反流性疾病患者的循證治療. 中國循證醫學雜志, 2011, 11(4): 468-472. doi: 10.7507/1672-2531.20110081 復制

1.	2 Corley DA, Kubo A. Body mass index and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Gastroenterol , 2006, 101(11): 2619-2628.
2.	中華醫學會消化內鏡學分會. 反流性食管炎診斷及治療指南（2003）. 中華消化內鏡雜志, 2004, 21(4): 221-222.
3.	El-Serag H. The association between obesity and GERD: a review of the epidemiological evidence. Dig Dis Sci , 2008, 53(9): 2307-2312.
4.	Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med , 2005, 143(3): 199-211.
5.	Piesman M, Hwang I, Maydonovitch C, et al . Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter? Am J Gastroenterol , 2007, 102(10): 2128-2134.
6.	DiBaise JK. A randomized, double-blind comparison of two different coffee-roasting processes on development of heartburn and dyspepsia in coffee-sensitive individuals. Dig Dis Sci , 2003, 48(4): 652-656.
7.	Cook MB, Kamangar F, Whiteman DC, et al . Cigarette smoking and adenocarcinomas of the esophagus and esophagogastric junction: a pooled analysis from the international BEACON consortium. J Natl Cancer Inst , 2010, 102(17): 1344-1353.
8.	Edelstein ZR, Bronner MP, Rosen SN, et al . Risk factors for Barrett's esophagus among patients with gastroesophageal reflux disease: a community clinic-based case-control study. Am J Gastroenterol , 2009, 104(4): 834-842.
9.	Pehl C, Wendl B, Pfeiffer A. White wine and beer induce gastro-oesophageal reflux in patients with reflux disease. Aliment Pharmacol Ther , 2006, 23(11): 1581-1586.
10.	Colombo P, Mangano M, Bianchi PA, et al . Effect of calories and fat on postprandial gastro-oesophageal reflux. Scand J Gastroenterol, 2002, 37(1): 3-5.
11.	Galmiche JP, Fraitag B, Filoche B, et al . Double-blind comparison of cisapride and cimetidine in treatment of reflux esophagitis. Dig Dis Sci , 1990, 35(5): 649-655.
12.	Khan M, Santana J, Donnellan C, et al . Medical treatments in the short term management of reflux oesophagitis. Cochrane Database Syst Rev , 2007, 18(2): CD003244.
13.	van Pinxteren B, Numans ME, Bonis PA, et al . Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. Cochrane Database Syst Rev , 2006, 19(3): CD002095.
14.	Cutler A, Robinson M, Murthy A, et al . Rabeprazole 20 mg for erosive esophagitis-associated symptoms in a large, community-based study: additional results. Dig Dis Sci , 2010, 55(2): 338-345.
15.	Pace F, Annese V, Prada A, et al . Rabeprazole is equivalent to omeprazole in the treatment of erosive gastro-oesophageal reflux disease. A randomised, double-blind, comparative study of rabeprazole and omeprazole 20 mg in acute treatment of reflux oesophagitis, followed by a maintenance open-label, low-dose therapy with rabeprazole. Dig Liver Dis, 2005, 37(10): 741-750.
16.	Edwards SJ, Lind T, Lundell L. Systematic review: proton pump inhibitors (PPIs) for the healing of reflux oesophagitis - a comparison of esomeprazole with other PPIs. Aliment Pharmacol Ther , 2006, 24(5): 743-750.
17.	鐘捷譯. 埃索美拉唑與奧美拉唑對胃食管反流病24小時胃內PH效果比較. 中華消化雜志, 2003, 23(8): 391-492.
18.	Kiljander TO, Junghard O, Beckman O, et al . Effect of esomeprazole 40 mg once or twice daily on asthma: a randomized, placebo-controlled study. Am J Respir Crit Care Med , 2010, 181(10):1042-1048.
19.	Wu JC, Chan FK, Ching JY, et al . Effect of Helicobacter pylori eradication on treatment of gastro-esophageal reflux disease: a double blind, placebo controlled, randomized trial. Gut , 2004, 53(2):174-179.
20.	Giannini EG, Zentilin P, Dulbecco P, et al . Management strategy for patients with gastroesophageal reflux disease: a comparison between empirical treatment with esomeprazole and endoscopy-oriented treatment. Am J Gastroenterol , 2008, 103(2): 267-275.
21.	Goh KL, Benamouzig R, Sander P, Efficacy of pantoprazole 20 mg daily compared with esomeprazole 20 mg daily in the maintenance of healed gastroesophageal reflux disease: a randomized, double-blind comparative trial - the EMANCIPATE study. Eur J Gastroenterol Hepatol , 2007, 19(3): 205-211.
22.	Toussaint J, Gossuin A, Deruyttere M. Healing and prevention of relapse of reflux oesophagitis by cisapride. Gut , 1991, 32(11): 1280-1285.
23.	DeVault KR, Castell DO, American College of Gastroenterology. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol , 2005, 100(1): 190-200.
24.	Yaghoobi M, Farrokhyar F, Yuan Y, et al . Is there an increased risk of GERD after Helicobacter pylori eradication?: a meta-analysis. Am J Gastroenterol , 2010, 105(5): 1007-1013.
25.	Schröder S, van Hülst S, Raabe W, et al . Nasojejunal enteral feeding tubes in critically ill patients. Successful placement without technical assistance. Anaesthesist , 2007, 56(12): 1217-1222.
26.	Aziz AM, El-Khayat HR, Sadek A, et al . A prospective randomized trial of sham, single-dose Stretta, and double-dose Stretta for the treatment of gastroesophageal reflux disease. Surg Endosc , 2010, 24(4): 818-825.
27.	Meneghelli UG, Boaventura S, Moraes-Filho JP, et al . Efficacy and tolerability of pantoprazole versus ranitidine in the treatment of reflux esophagitis and the influence of Helicobacter pylori infection on healing rate. Dis Esophagus , 2002, 15(1): 50-56.
28.	Salminen PT, Hiekkanen HI, Rantala AP, et al . Comparison of long-term outcome of laparoscopic and conventional nissen fundoplication: a prospective randomized study with an 11-year follow-up. Ann Surg , 2007, 246(2): 201-206.
29.	Heikkinen TJ, Haukipuro K, Koivukangas P. Comparison of costs between laparoscopic and open Nissen fundoplication: a prospective randomized study with a 3-month followup. J Am CollSurg , 1999, 188(4): 368-376.
30.	Kösek V, Wykypiel H, Weiss H, et al . Division of the short gastric vessels during laparoscopic Nissen fundoplication: clinical and functional outcome during long-term follow-up in a prospectively randomized trial. Surg Endosc , 2009, 23(10): 2208-2213.
31.	Broeders JA, Rijnhart-de Jong HG, Draaisma WA, et al . Ten-year outcome of laparoscopic and conventional nissen fundoplication: randomized clinical trial. Ann Surg , 2009, 250(5): 698-706.
32.	Shaw JM, Bornman PC, Callanan MD, et al . Long-term outcome of laparoscopic Nissen and laparoscopic Toupet fundoplication for gastroesophageal reflux disease: a prospective, randomized trial. Surg Endosc , 2010, 24(4): 924-932.
33.	Epstein D, Bojke L, Sculpher MJ, et al . Laparoscopic fundoplication compared with medical management for gastro-oesophageal reflux disease: cost effectiveness study. BMJ , 2009, 339:b2576. doi: 10.1136/bmj.b2576.

1. 2 Corley DA, Kubo A. Body mass index and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Gastroenterol , 2006, 101(11): 2619-2628.
2. 中華醫學會消化內鏡學分會. 反流性食管炎診斷及治療指南（2003）. 中華消化內鏡雜志, 2004, 21(4): 221-222.
3. El-Serag H. The association between obesity and GERD: a review of the epidemiological evidence. Dig Dis Sci , 2008, 53(9): 2307-2312.
4. Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med , 2005, 143(3): 199-211.
5. Piesman M, Hwang I, Maydonovitch C, et al . Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter? Am J Gastroenterol , 2007, 102(10): 2128-2134.
6. DiBaise JK. A randomized, double-blind comparison of two different coffee-roasting processes on development of heartburn and dyspepsia in coffee-sensitive individuals. Dig Dis Sci , 2003, 48(4): 652-656.
7. Cook MB, Kamangar F, Whiteman DC, et al . Cigarette smoking and adenocarcinomas of the esophagus and esophagogastric junction: a pooled analysis from the international BEACON consortium. J Natl Cancer Inst , 2010, 102(17): 1344-1353.
8. Edelstein ZR, Bronner MP, Rosen SN, et al . Risk factors for Barrett's esophagus among patients with gastroesophageal reflux disease: a community clinic-based case-control study. Am J Gastroenterol , 2009, 104(4): 834-842.
9. Pehl C, Wendl B, Pfeiffer A. White wine and beer induce gastro-oesophageal reflux in patients with reflux disease. Aliment Pharmacol Ther , 2006, 23(11): 1581-1586.
10. Colombo P, Mangano M, Bianchi PA, et al . Effect of calories and fat on postprandial gastro-oesophageal reflux. Scand J Gastroenterol, 2002, 37(1): 3-5.
11. Galmiche JP, Fraitag B, Filoche B, et al . Double-blind comparison of cisapride and cimetidine in treatment of reflux esophagitis. Dig Dis Sci , 1990, 35(5): 649-655.
12. Khan M, Santana J, Donnellan C, et al . Medical treatments in the short term management of reflux oesophagitis. Cochrane Database Syst Rev , 2007, 18(2): CD003244.
13. van Pinxteren B, Numans ME, Bonis PA, et al . Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. Cochrane Database Syst Rev , 2006, 19(3): CD002095.
14. Cutler A, Robinson M, Murthy A, et al . Rabeprazole 20 mg for erosive esophagitis-associated symptoms in a large, community-based study: additional results. Dig Dis Sci , 2010, 55(2): 338-345.
15. Pace F, Annese V, Prada A, et al . Rabeprazole is equivalent to omeprazole in the treatment of erosive gastro-oesophageal reflux disease. A randomised, double-blind, comparative study of rabeprazole and omeprazole 20 mg in acute treatment of reflux oesophagitis, followed by a maintenance open-label, low-dose therapy with rabeprazole. Dig Liver Dis, 2005, 37(10): 741-750.
16. Edwards SJ, Lind T, Lundell L. Systematic review: proton pump inhibitors (PPIs) for the healing of reflux oesophagitis - a comparison of esomeprazole with other PPIs. Aliment Pharmacol Ther , 2006, 24(5): 743-750.
17. 鐘捷譯. 埃索美拉唑與奧美拉唑對胃食管反流病24小時胃內PH效果比較. 中華消化雜志, 2003, 23(8): 391-492.
18. Kiljander TO, Junghard O, Beckman O, et al . Effect of esomeprazole 40 mg once or twice daily on asthma: a randomized, placebo-controlled study. Am J Respir Crit Care Med , 2010, 181(10):1042-1048.
19. Wu JC, Chan FK, Ching JY, et al . Effect of Helicobacter pylori eradication on treatment of gastro-esophageal reflux disease: a double blind, placebo controlled, randomized trial. Gut , 2004, 53(2):174-179.
20. Giannini EG, Zentilin P, Dulbecco P, et al . Management strategy for patients with gastroesophageal reflux disease: a comparison between empirical treatment with esomeprazole and endoscopy-oriented treatment. Am J Gastroenterol , 2008, 103(2): 267-275.
21. Goh KL, Benamouzig R, Sander P, Efficacy of pantoprazole 20 mg daily compared with esomeprazole 20 mg daily in the maintenance of healed gastroesophageal reflux disease: a randomized, double-blind comparative trial - the EMANCIPATE study. Eur J Gastroenterol Hepatol , 2007, 19(3): 205-211.
22. Toussaint J, Gossuin A, Deruyttere M. Healing and prevention of relapse of reflux oesophagitis by cisapride. Gut , 1991, 32(11): 1280-1285.
23. DeVault KR, Castell DO, American College of Gastroenterology. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol , 2005, 100(1): 190-200.
24. Yaghoobi M, Farrokhyar F, Yuan Y, et al . Is there an increased risk of GERD after Helicobacter pylori eradication?: a meta-analysis. Am J Gastroenterol , 2010, 105(5): 1007-1013.
25. Schröder S, van Hülst S, Raabe W, et al . Nasojejunal enteral feeding tubes in critically ill patients. Successful placement without technical assistance. Anaesthesist , 2007, 56(12): 1217-1222.
26. Aziz AM, El-Khayat HR, Sadek A, et al . A prospective randomized trial of sham, single-dose Stretta, and double-dose Stretta for the treatment of gastroesophageal reflux disease. Surg Endosc , 2010, 24(4): 818-825.
27. Meneghelli UG, Boaventura S, Moraes-Filho JP, et al . Efficacy and tolerability of pantoprazole versus ranitidine in the treatment of reflux esophagitis and the influence of Helicobacter pylori infection on healing rate. Dis Esophagus , 2002, 15(1): 50-56.
28. Salminen PT, Hiekkanen HI, Rantala AP, et al . Comparison of long-term outcome of laparoscopic and conventional nissen fundoplication: a prospective randomized study with an 11-year follow-up. Ann Surg , 2007, 246(2): 201-206.
29. Heikkinen TJ, Haukipuro K, Koivukangas P. Comparison of costs between laparoscopic and open Nissen fundoplication: a prospective randomized study with a 3-month followup. J Am CollSurg , 1999, 188(4): 368-376.
30. Kösek V, Wykypiel H, Weiss H, et al . Division of the short gastric vessels during laparoscopic Nissen fundoplication: clinical and functional outcome during long-term follow-up in a prospectively randomized trial. Surg Endosc , 2009, 23(10): 2208-2213.
31. Broeders JA, Rijnhart-de Jong HG, Draaisma WA, et al . Ten-year outcome of laparoscopic and conventional nissen fundoplication: randomized clinical trial. Ann Surg , 2009, 250(5): 698-706.
32. Shaw JM, Bornman PC, Callanan MD, et al . Long-term outcome of laparoscopic Nissen and laparoscopic Toupet fundoplication for gastroesophageal reflux disease: a prospective, randomized trial. Surg Endosc , 2010, 24(4): 924-932.
33. Epstein D, Bojke L, Sculpher MJ, et al . Laparoscopic fundoplication compared with medical management for gastro-oesophageal reflux disease: cost effectiveness study. BMJ , 2009, 339:b2576. doi: 10.1136/bmj.b2576.

《中國循證醫學雜志》

一例初診胃食管反流性疾病患者的循證治療

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《中國循證醫學雜志》

一例初診胃食管反流性疾病患者的循證治療

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