法莫替丁治疗反流性食管炎多中心临床观察

Famotidine in the treatment of reflux esophagitis:a multicenter study

目的 探讨不同剂量法莫替丁 (商品名 :高舒达 )对反流性食管炎 (RE)的疗效。方法 上海地区 4家医院将 89例经内镜证实的 (洛杉矶分级A级和B级 )RE患者随机分为两组 ,A组 4 6例予以法莫替丁 2 0mg ,每日 2次 ;B组 4 3例予以双倍剂量 ,即 4 0mg ,每日 2次。分别于治疗后 2、4、6、8及 12周观察烧心、反酸、胸痛等症状疗效 ,并于 12周后复查胃镜 ,观察镜下愈合率 ,A组中 9例、B组中 10例患者分别与治疗前及治疗后进行食管 2 4hpH监测。 结果 法莫替丁治疗 2周 ,即可见症状明显改善 ,症状记分较治疗前明显下降 (P <0 .0 1) ,继续用药至第 12周 ,症状记分较第 2周亦显著下降 (P <0 .0 1) ,两组在治疗前及治疗后不同时间症状积分下降值均差异无显著性。治疗 12周时 ,A组症状消失率为 5 2 .17% ,总有效率为 84 .78% ;B组症状消失率为 4 8.83% ,总有效率为 88.37%。两组在症状消失率及有效率方面均差异无显著性 (P >0 .0 5 )。A组食管炎内镜下愈合率为 4 7.83% ,有效率为 82 .6 1% ;B组愈合率为 4 6 .5 1% ,有效率为 86 .0 5 %。两组在内镜下食管炎愈合率及有效率方面均差异无显著性(P >0 .0 5 )。食管 2 4hpH监测显示 ,法莫替丁 4 0mg ,每日 2次患者食管酸暴露次数较治疗前明显减少(P <0 .0 5 )。

Objective To investigate the effect of famotidine on reflux esophagitis. Methods Eight-nine patients with endoscopically proven reflux esophagitis (Los Angles classification A or B grade) were assessed from 4 hospitals in Shanghai. Patients were randomly divided into two groups, 46 patients in group A received famotidine 20 mg twice daily, while 43 patients in group B received famotidine 40 mg twice daily. Reflux symptoms including heartburn, regurgitation and non-cardiac chest pain were evaluated at clinic visits in 2,4,6,8 and 12 weeks, respectively. At 12 weeks, endoscopy was performed to evaluate the healing rate, and esophageal 24 hours pH monitoring was carried out in 9 patients of group A and 10 patients of group B. Results After 2 weeks' treatment with famotidine, all the symptoms had improved, and symptom scores were greatly decreased ( P <0.01). Symptom relief was achieved in 52.17% and 48.83% of patients in group A and group B respectively, whereas the total symptom improvement rate was 84.78% and 88.37% respectively. At the end of the treatment, the healing rate was 47.83% in group A and 46.51% in group B. There were no significant differences of symptom improvement rate and esophagitis healing rate between two groups. Esophageal 24 hours pH monitoring showed that the total number of pH<4 decreased significantly ( P < 0.05) only in patients with famotidine 40 mg twice daily at the end of the treatment. Conclusions Famotidine is effective in the treatment of mild to moderate severity of reflux esophagitis. There is no significant increase in esophagitis healing rate in double dose group.