质子泵抑制剂治疗对胃食管反流病患者食管酸暴露的影响

The impact of proton pump inhibitors on esophageal acid exposure in gastroesophageal reflux disease

目的探讨质子泵抑制剂（PPIs）治疗对胃食管反流病（GERD）患者食管酸暴露的影响及焦虑抑郁情绪与GERD患者PPI停药后酸相关症状再发的相关性。方法2010年2月至2011年6月北京积水潭医院经24h食管pH动态监测确诊的GERD患者28例（男16例，女12例），给予口服埃索美拉唑20mg2次／d，治疗8周。监测停药后症状，对停药后8周内有症状复发者，复查24h食管pH动态监测。同时测定患者的BMI、焦虑自评量表（SAS）积分、抑郁自评量表（SDS）积分。结果28例GERD患者中，停药后症状复发者15例（53．6％）。PPI停药后症状复发者较无症状复发者治疗前的pH〈4时间百分比（卧位）、24h酸反流总时间、24h酸反流〉5min时间段数、最长酸反流时间、24h总反流次数均明显更高（分别为11．7％比4．5％，138．8min比62．1min，6．0比2．0，27．0min比12．4min，74．0次比43．0次，P值均〈0．05）。各组GERD患者BMI、SAS积分、SDS积分比较，差异无统计学意义。结论GERD患者接受PPI治疗前基础食管酸暴露水平可能对PPI治疗后食管酸暴露产生影响，从而影响症状的再发。虽然焦虑抑郁在GERD患者中普遍存在，但未发现焦虑抑郁情绪与GERD患者PPI治疗停药后酸相关症状的再发相关。

Objective To explore the effects of proton pump inhibitors （PPIs） therapy on esophageal acid exposure of patients with gastroesophageal reflux disease （ GERD ） , and the correlation of anxiety and depression with recurrence of acid-related symptoms after discontinuation of PPIs. Methods From February 2010 to June 2011, 28 patients with GERD diagnosed by ambulatory 24 h esophageal pH monitoring admitted to Beijing Jishuitan Hospital were treated with esomeprazole 20 mg 2 times/d for 8 weeks （male 16, female 12）. Symptoms after drug discontinuation were monitored. Ambulatory 24 h esophageal pH monitoring was performed on patients, whose symptom recurred within 8 weeks after treatment. BMI, Self-rating Anxiety Scale （SAS）, and Self-rating Depression Scale （SDS） were detected. Results Among the 28 patients with GERD, 15 （53.6%） recurred symptoms after withdraw of PPIs. Compared with the asymptomatic group after withdraw of PPIs, the pretreatment duration of pH 4 （ supine）, 24 h total acid reflux time, number of time periods with acid reflux 〉 5 minutes, the maximal acid reflux time and 24 h total number of acid reflux in the symptomatic recurrence group were statistically significantly increased （11.7% vs 4. 5%, 138.8 minutes vs 62. 1 minutes, 6. 0 vs 2. 0, 27. 0 minutes vs 12.4 minutes, 74. 0 times vs 43.0 times, respectively, all P values 〈 0. 05 ）. There were no significant differences in BMI, SAS and SDS between the two groups. Conclusions The basic level of esophageal acid exposure of patients with GERD before PPIs therapy may influence the esophageal acid exposure after PPIs therapy and then may affect the recurrence of symptoms. Although anxiety and depression is common in patients with GERD, it is not found that the recurrence of acid-related symptoms after the discontinuation of PPIs therapy is related to the anxiety and depression.