【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。更多还原

【Abstract】 Objective To investigate the efficacy of long-term maintenance therapy on gastroesophageal reflux disease(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 disease(NERD),erosive esophagitis(EE) and Barrett’s esophagus(BE) respectively,after 3 years of prospective follow-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-demand treatment may has advantage when considering cost-effectiveness as well as compliance;a small number of reciprocal transformations might occur between NERD and low grade of EE.更多还原