A randomized open-label trial of on-demand rabeprazole vs ranitidine for patients with non-erosive reflux disease

AIM： To compare the efficacy of the proton-pump inhibitor, rabeprazole, with that of the H2-receptor antagonist, ranitidine, as on-demand therapy for relieving symptoms associated with non-erosive reflux disease （NEED）.METHODS： This is a single center, prospective, randomized, open-label trial of on-demand therapy with rabeprazole （group A） vs ranitidine （group B） for 4 wk. Eighty-three patients who presented to the American University of Beirut Medical Center with persistent gas- troesophageal reflux disease （GERD） symptoms and a normal upper gastrointestinal endoscopy were eligible for the study. Patients in group A （n = 44） were al-lowed a maximum rabeprazole dose of 20 mg twice daily, while those in group B （n = 39） were allowed a maximum ranitidine dose of 300 mg twice daily. Ef- ficacy was assessed by patient evaluation of global symptom relief, scores of the SF-36 quality of life （QoL） questionnaires, total number of pills used, and number of medication-free days.RESULTS： Among the 83 patients who were enrolled in the study, 76 patients （40 in the rabeprazole group and 36 in the ranitidine group） completed the 4-wk trial. Baseline characteristics were comparable between both groups. After 4 wk, there was no significant difference in the subjective global symptom relief between the rabeprazole and the ranitidine groups （71.4% vs 65.4%, respectively; P = 0.9）. There were no statistically significant differences between mean cumulative scores of the SF-36 QoL questionnaire for the two study groups （rabeprazole 22.40±27.53 vs ranitidine 17.28 ± 37.06; P = 0.582）. There was no significant difference in the mean number of pills used （rabeprazole 35.70±29.75 vs ranitidine 32.86±26.98; P = 0.66）. There was also no statistically significant difference in the mean number of medication-free days between both groups.CONCLUSION： Rabeprazole has a comparable efficacy compared to ranitidine when given on-demand for the treatment of NERD. Both medications were associated with improved quality of life.

Impact of body mass index and gender on quality of life in patients with gastroesophageal reflux disease

AIM： To investigate the symptom presentation and quality of life in obese Chinese patients with gastro- esophageal reflux disease （GERD）. MKTHODS： Data from patients diagnosed with GERD according to the Montreal definition, were collected between January 2009 to March 2010. The enrolled patients were assigned to the normal [body mass in- dex （BMI） 〈 25 kg/m2], overweight （25-30 kg/m2）, and obese （BMI 〉 30 kg/m2） groups. General demographic data, endoscopic findings, and quality of life of the three groups of patients were analyzed and compared.and 15 patients were classified in the normal, over- weight, and obese, respectively. There was significantly more erosive esophagitis （73.3% vs 64.3% vs 39.2%, P = 0.002）, hiatal hernia （60% vs 33.9% vs 16.7%, P = 0.001）, and males （73.3% vs 73.2% vs 32.4%, P = 0.001） in the obese cases. The severity and frequency of heartburn, not acid regurgitation, was positively cor- related with BMI, with a significant association in men, but not in women. Obese patients were prone to have low quality of life scores, with obese women having the lowest scores for mental health. CONCLUSION： In patients with GERD, obese men had the most severe endoscopic and clinical presenta- tion. Obese women had the poorest mental health.

Irsogladine maleate and rabeprazole in non-erosive reflux disease: A double-blind, placebo-controlled study

AIM:To evaluate the efficacy of adding irsogladine maleate(IM) to proton-pump inhibitor(PPI) therapy in non-erosive reflux disease(NERD) treatment.METHODS:One hundred patients with NERD were recruited and randomized to receive rabeprazole plus IM(group I) or rabeprazole plus placebo(group P).The efficacy of the treatment was assessed using the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease(FSSG) and the short form(SF)-36 quality of life questionnaires after four weeks of treatment.We also assessed whether patients with NERD with minimal changes(grade M) had different responses to the therapies compared with patients who did not have minimal changes(grade N).RESULTS:Group I and group P showed significant improvements in their FSSG scores after the treatment(from 17.9 ± 7.9 to 9.0 ± 7.6, and from 17.7 ± 7.3 to 11.2 ± 7.9, respectively, P = 0.0001), but there was no statistically significant difference between the FSSG scores in group I and those in group P.Subgroup analysis showed that significant improvements in the FSSG scores occurred in the patients in group I who had NERD grade N(modified Los Angeles classification)(7.8 ± 7.4 vs 12.5 ± 9.8, P = 0.041).The SF-36 scores for patients with NERD grade N who had received IM and rabeprazole were significantly improved in relation to their vitality and mental health scores.CONCLUSION:The addition of IM to rabeprazole significantly improves gastroesophageal reflux diseasesymptoms and the quality of the lives of patients with NERD grade N.

Impact of gastroesophageal reflux disease on the quality of life of Polish patients

BACKGROUND Gastro-esophageal reflux disease (GERD) is a serious health and social problem leading to a considerable decrease in the quality of life of patients. Among the risk factors associated with reflux symptoms and that decrease the quality of life are stress, overweight and an increase in body weight. The concept of healthrelated quality of life (HRQL) covers an expanded effect of the disease on a patient’s wellbeing and daily activities and is one of the measures of widely understood quality of life. HRQL is commonly measured using a selfadministered, disease-specific questionnaires. AIM To determine the effect of reflux symptoms, stress and body mass index (BMI) on the quality of life. METHODS The study included 118 patients diagnosed with reflux disease who reported to an outpatient department of gastroenterology or a specialist hospital ward for planned diagnostic tests. Assessment of the level of reflux was based on the frequency of 5 typical of GERD symptoms. HRQL was measured by a 36-item Short Form Health Survey (SF-36) and level of stress using the 10-item Perceived Stress Scale. Multi-variable relationships were analyzed using multiple regression. RESULTS Eleven models of analysis were performed in which the scale of the SF-36 was included as an explained variable. In all models, the same set of explanatory variables: Gender, age, reflux symptoms, stress and BMI, were included. The frequency of GERD symptoms resulted in a decrease in patients’ results according to 6 out of 8 SF-36 scales- except for mental health and vitality scales. Stress resulted in a decrease in patient function in all domains measured using the SF-36. Age resulted in a decrease in physical function and in overall assessment of self-reported state of health. An increasing BMI exerted a negative effect on physical fitness and limitations in functioning resulting from this decrease. CONCLUSION In GERD patients, HRQL is negatively determined by the frequency of reflux symptoms and by stress, furthermore an increasing BMI and age decreases the level of physical function.

Evaluation of the Quality of Life in Pre- and Post-Operatory in Patients Submitted to Surgical Treatment of Reflux Disease and Hiato Hernia

Gastroesophageal reflux disease affects 40% of the population in industrialized countries. GERD has a negative impact on the quality of life of affected patients. Although PPIs induce a good response in the control of symptoms, the need for prolonged use of the medication and the fact that more than a third of the patients have symptoms even after its correct use, make surgery, an alternative for the treatment of the disease. The aims of this study were to compare the quality of life related to GERD before and after MIS surgical treatment of GERD and/or hiatus hernia, and to analyze the results and complications of the MIS treatment of GERD. Methods: For retrospective analysis, the electronic database of patients with indications for surgical treatment due to GERD and/or patients with sliding or paraesophageal hernias was examined. The study included patients from Hospital Universitário Gaffrée e Guinle and the Postgraduate Course in General Surgery at PUC-Rio (Rio de Janeiro, Brazil) who underwent surgery using video laparoscopy or robotic surgery between January 2013 and March 2020. This is an observational, longitudinal, descriptive study with retrospective analysis of the data. Surgical treatment was indicated due to incomplete response to clinical treatment, young age with persistent symptoms, or complications of GERD. Patients with hiatus and/or paraesophageal hernia with indication for surgical treatment were included. Results: The study evaluated 160 patients who underwent anti-reflux surgery by laparoscopic or robotic surgery in the period from 2013 to 2020. A total of 88 women and 72 men were operated, mean 46.6 ± 13.7 years. An improvement in the preoperative QS-GERD scores compared to the postoperative scores was observed (27.56 ± 10.93 vs 1.4 ± 2.47, p < 0.01). Additionally, it was observed that there was no association between worse prognosis and failure rate with gender, sex, age, body mass index, surgical technique, or the number of sutures on the fundoplication valve. The length of hospital stay was 24 hours in 74.2% of patients, 48 hours in 19.3%, and 72 hours in 4.6%, with a global median of 24 hours and a mean of 28.7 hours. No patient required blood transfusion;none had early postoperative complications (seroma, wound infection, or eventration), or died. Conclusion: A significant drop in the QS-GERD score was found before and after the surgical treatment of GERD and or hiatus hernia. The MIS surgical treatment of GERD controlled the symptoms in most of the treated individuals, presenting a low rate of complications without mortality.

Heartburn and regurgitation have different impacts on life quality of patients with gastroesophageal reflux disease

AIM: To investigate the impact of heartburn and regurgitation on the quality of life among patients with gastroesophageal reflux disease (GERD).

Epidemiological, Clinical Aspects and Factors Associated with Typical Gastroesophageal Reflux Disease in the General Population of Parakou, Republic of Benin

Introduction: Gastroesophageal reflux disease (GERD) is a benign and chronic disease that can impair the quality of life. Objective: To study the epidemiological, clinical aspects and factors associated with typical GERD in the general population of Parakou in the Republic of Benin. Methods: This was a descriptive and analytical cross-sectional study with prospective data collection which took place from May 1, 2019 to June 30, 2019. The study population consisted of any subject aged at least 15 years and living in Parakou. Subjects aged at least 15 years, present on the day of the survey and having given their free and informed verbal consent were included. The Short form of QRS®(Reflux-Qual Short form) questionnaire and the “Hospital Anxiety and Depression” score were used to assess the quality of life and anxiety/depression, respectively. The sampling was probabilistic through a 2-stage cluster sampling. The variable of interest was the presence of GERD. Results: Out of 390 subjects surveyed, 28 had symptoms of typical GERD, representing a prevalence of 7.18%. The average age of these subjects was 27.11 ± 7.88 years. Fifteen subjects (53.57%) were male, giving a sex ratio of 1.15. Fourteen (50%) had a secondary level of education, 12 (42.86%) were pupils/students, 18 (64.29%) were single. The monthly income of 22 subjects (78.57%) was lower than the guaranteed interprofessional minimum wage (40,000 FCFA). The average duration of progression of symptoms was 15.89 ± 4.97 months. Symptoms occurred less than twice a week in 22 subjects (78.57%). The clinical manifestations were both diurnal and nocturnal in 12 subjects (42.86%). None of the 28 subjects with GERD had clinical warning signs. Asthma, diabetes, consumption of high fat or spice foods, carbonated drinks, non-steroidal anti-inflammatory drugs, alcoholic beverages and tobacco were statistically associated with the occurrence of GERD. Each of the 28 subjects had at least one associated factor. A significant impair in quality of life was observed in 27 patients (96.43%). Conclusion: Typical GERD is relatively common in the general population of Parakou in the Republic of Benin. It often affects young males. Among the risk factors identified, the most common are carbonated drinks, spicy meals and diabetes. GERD significantly impairs quality of life. Raising awareness about the disease and its associated factors is necessary among the general population.

Endoscopic full-thickness plication along with argon plasma coagulation for treatment of proton pump inhibitor dependent gastroesophageal reflux disease

BACKGROUND Most endoscopic anti-reflux interventions for gastroesophageal reflux disease(GERD)management are technically challenging to practice with inadequate data to support it utility.Therefore,this study was carried to evaluate the effectiveness and safety newer endoscopic full-thickness fundoplication(EFTP)device along with Argon Plasma Coagulation to treat individuals with GERD.AIM To evaluate the effectiveness and safety newer EFTP device along with Argon Plasma Coagulation to treat individuals with GERD.METHODS This study was a single-center comparative analysis conducted on patients treated at a Noble Institute of Gastroenterology,Ahmedabad,hospital between 2020 and 2022.The research aimed to retrospectively analyze patient data on GERD symptoms and proton pump inhibitor(PPI)dependence who underwent EFTP using the GERD-X system along with argon plasma coagulation(APC).The primary endpoint was the mean change in the total gastroesophageal reflux disease health-related quality of life(GERD-HRQL)score compared to the baseline measurement at the 3-month follow-up.Secondary endpoints encompassed enhancements in the overall GERD-HRQL score,improvements in GERD symptom scores at the 3 and changes in PPI usage at the 3 and 12-month time points.RESULTS In this study,patients most were in Hill Class II,and over half had ineffective esophageal motility.Following the EFTP procedure,there were significant improvements in heartburn and regurgitation scores,as well as GERDHRQL scores(P<0.001).PPI use significantly decreased,with 82.6%not needing PPIs or prokinetics at end of 1 year.No significant adverse events related to the procedures were observed in either group.CONCLUSION The EFTP along with APC procedure shows promise in addressing GERD symptoms and improving patients'quality of life,particularly for suitable candidates.Moreover,the application of a lone clip with APC yielded superior outcomes and exhibited greater cost-effectiveness.

LINX^(■) reflux management system to bridge the “treatment gap” in gastroesophageal reflux disease: A systematic review of 35 studies

BACKGROUND Gastroesophageal reflux disease(GERD) occurs when the reflux of stomach contents causes troublesome symptoms and/or complications. When medical therapy is insufficient, surgical therapy is indicated and, until now, Laparoscopic fundoplication(LF) constitutes the gold-standard method. However, magnetic sphincter augmentation(MSA) using the LINX^® Reflux Management System has recently emerged and disputes the standard therapeutic approach.AIM To investigate the device’s safety and efficacy in resolving GERD symptoms.METHODS This is a systematic review conducted in accordance to the PRISMA guidelines.We searched MEDLINE, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL databases from inception until September 2019.RESULTS Overall, 35 studies with a total number of 2511 MSA patients were included and analyzed. Post-operative proton-pump inhibitor(PPI) cessation rates reached 100%, with less bloating symptoms and a better ability to belch or vomit in comparison to LF. Special patient groups(e.g., bariatric or large hiatal-hernias)had promising results too. The most common postoperative complication was dysphagia ranging between 6% and 83%. Dilation due to dysphagia occurred in 8% of patients with typical inclusion criteria. Esophageal erosion may occur in up to 0.03% of patients. Furthermore, a recent trial indicated MSA as an efficient alternative to double-dose PPIs in moderate-to-severe GERD.CONCLUSION The findings of our review suggest that MSA has the potential to bridge the treatment gap between maxed-out medical treatment and LF. However, further studies with longer follow-up are needed for a better elucidation of these results.

Gastroesophageal reflux disease management according to contemporary international guidelines:A translational study

AIM:To test the Genval recommendations and the usefulness of a short trial of proton pump inhibitor(PPI) in the initial management and maintenance treatment of gastroesophageal reflux disease(GERD)patients. METHODS:Five hundred and seventy seven patients with heartburn were recruited.After completing a psychometric tool to assess quality of life(PGWBI)and a previously validated GERD symptom questionnaire (QUID),patients were grouped into those with esophagitis(EE,n=306)or without mucosal damage (NERD,n=271)according to endoscopy results. The study started with a 2-wk period of high dose omeprazole(omeprazole test);patients responding to this PPI test entered an acute phase(3 mo)of treatment with any PPI at the standard dose.Finally,those patients with a favorable response to the standard PPI dose were maintained on a half PPI dose for a further 3-mo period. RESULTS:The test was positive in 519(89.9%)patients,with a greater response in EE patients(96.4%) compared with NERD patients(82.6%)(P=0.011). Both the percentage of completely asymptomatic patients,at 3 and 6 mo,and the reduction in heartburn intensity were significantly higher in the EE compared with NERD patients(P<0.01).Finally,the mean PGWBI score was significantly decreased before and increased after therapy in both subgroups when compared with the mean value in a reference Italian population. CONCLUSION:Our study confirms the validity of the Genval guidelines in the management of GERD patients. In addition,we observed that the overall response to PPI therapy is lower in NERD compared to EE patients.

柴胡加龙骨牡蛎汤加减辅助治疗肝胃郁热型胃食管反流病临床研究

目的:观察柴胡加龙骨牡蛎汤加减辅助治疗肝胃郁热型胃食管反流病的临床疗效。方法:采用随机数字表法将96例肝胃郁热型胃食管反流病患者分为治疗组与对照组各48例。对照组接受艾司奥美拉唑和莫沙必利治疗,治疗组在对照组基础上联合柴胡加龙骨牡蛎汤加减治疗,2组连续治疗8周。比较2组临床疗效及治疗前后反流性疾病问卷(RDQ)、食管黏膜分级评分、中医证候积分、匹兹堡睡眠质量指数(PSQI)评分、健康状况量表(SF-36)评分、食管动力学指标。结果:治疗后,治疗组总有效率89.58%,高于对照组75.00%(P<0.05)。治疗后,2组中医证候积分、RDQ评分、食管黏膜分级评分、PSQI评分均较治疗前降低(P<0.05),且治疗组上述指标低于对照组(P<0.05)。治疗后,2组食管下端括约肌静息压、远端收缩积分、SF-36评分均较治疗前升高(P<0.05),且治疗组上述食管动力学指标及SF-36评分高于对照组(P<0.05)。结论:柴胡加龙骨牡蛎汤加减辅助治疗肝胃郁热型胃食管反流病疗效确切,能够减轻患者消化道症状,改善食管动力学,提升睡眠质量和生活质量。

兰索拉唑联合度洛西汀治疗对胃食管反流病患者症状和生活质量的影响

目的 胃食管反流病(GERD)会对患者身心健康产生不良反应,分析兰索拉唑联合度洛西汀治疗方案的应用效果。方法 50例GERD患者,以随机数字表法分为对照组与研究组,每组25例。对照组采用兰索拉唑治疗,研究组在对照组基础上联合度洛西汀治疗。对比两组不良情绪与症状、食管远端平滑肌运动功能、生活质量。结果 治疗后,两组汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、胃食管反流病自测量表(GerdQ)评分均低于本组治疗前,且研究组HAMA评分(6.37±1.41)分、HAMD评分(10.28±0.41)分、GerdQ评分(5.37±0.49)分低于对照组的(9.27±2.05)、(13.27±0.62)、(9.25±2.41)分(P<0.05)。治疗后,两组食管下括约肌静息压(LESP)、下括约肌松弛率(LESRR)、远端收缩积分(DCI)均高于本组治疗前;且研究组食管LESP、LESRR、DCI分别为(20.26±1.89)mm Hg(1 mm Hg=0.133 kPa)、(99.37±8.14)%、(425.39±95.42)mm Hg·s·cm,高于对照组的(17.13±1.12)mm Hg、(90.27±7.46)%、(299.25±92.34)mm Hg·s·cm(P<0.05)。治疗后,两组烧心、吞咽、药物影响、一般健康状态评分均低于本组治疗前;且研究组烧心、吞咽、药物影响、一般健康状态评分分别为(2.19±0.11)、(2.19±0.37)、(2.35±0.15)、(2.38±0.16)分,低于对照组的(5.73±1.42)、(5.93±0.64)、(4.96±1.41)、(4.83±0.43)分(P<0.05)。结论 GERD患者不仅有躯体表现症状,且患者的心理状态也受到影响,应用兰索拉唑联合度洛西汀治疗方案有利于促进病情转归,改善患者不良情绪、生活质量,具有较高的临床应用价值,值得推广。

腹式深呼吸训练用于胃食管反流病患者的价值观察

目的探讨腹式深呼吸训练应用于胃食管反流病患者中的价值。方法选取2022年1月—2023年1月淄博一四八医院收治的胃食管反流病患者76例,采取奇偶分组法分为2组,各38例。参照组选择常规干预模式,试验组以参照组治疗方案为前提,结合腹式深呼吸训练方案。对2组干预效果进行评定。结果干预后,试验组焦虑抑郁程度低于参照组,生活质量评分高于参照组(P<0.05)。试验组干预后反酸评分为(1.12±0.13)分,低于参照组的(2.26±0.21)分(P<0.05)。试验组其余反流性疾病问卷评分低于参照组(P<0.05)。结论腹式深呼吸训练的应用有助于加快胃食管反流病患者症状的改善速度。同时,此种干预形式对缓解患者症状、提高其生活质量作用突出。

反流性食管炎和非糜烂性反流病患者症状谱、生活质量和精神心理状态调查

背景:胃食管反流病(GERD)包括非糜烂性反流病(NERD)、反流性食管炎(RE)和Barrett食管(BE),其发病机制可能有所不同。目的:分析比较NERD和RE患者的人口学特征和临床特点,为探讨其发病机制和有效治疗提供依据。方法:对连续入组的278例GERD患者进行问卷调查,内容包括一般人口学资料、胃食管反流以及相关症状评分、食管外症状、重叠症状、生活质量评价和精神心理状态评价。结果:NERD和RE分别占GERD的60.8%和37.1%;与RE组相比,NERD患者以女性多见(P<0.05),平均年龄较轻(P<0.05)。胃食管反流症状评分在两组患者间无显著差异,但RE组烧心频率较NERD组高(P<0.05),而NERD组胸骨后疼痛更突出,反食症状较轻。两组患者的食管外症状、重叠症状发生率无显著差异。NERD组患者生活质量下降更明显。NERD组患者合并精神心理异常的比例显著高于RE组(P<0.05),且抑郁评分高。结论:本组资料中大部分GERD患者为NERD,NERD和RE的反流以及相关症状谱无显著差异,但NERD患者常合并精神心理异常、生活质量下降,提示精神心理因素在NERD的发病中可能起重要作用。

埃索美拉唑对胃食管反流病患者症状和生活质量的影响

目的:探讨埃索美拉唑对胃食管反流病(GERD)患者症状和生活质量的影响.方法:采用前瞻、随机、阳性对照研究,将经内镜或24 h食管pH监测明确诊断的78例GERD患者随机分为标准剂量的埃索美拉唑(20 mg,2次/d,po)组和加倍剂量的奥美拉唑(20 mg,2次/d,po)组,每组39例.2组分别治疗8 wk,比较2组症状控制、RE内镜下有效率和愈合率、生活质量等区别.结果:共76例患者完成试验.埃索美拉唑组和奥美拉唑组各有1例RE因违反试验方案退出.4 wk和8 wk两组症状总积分治疗后均明显下降,但两组间差异无统计学意义.埃索美拉唑组和奥关拉唑组使NERD症状积分下降程度不如RE患者,但埃索美拉唑组使NERD患者症状积分下降优于奥美拉唑组(P<0.01);两组在烧心和胸痛缓解率上差异明显(78.3%vs 45.5%,64.3%vs 37.5%,均P<0.05),在反酸、咽下困难上无明显差异:4 wk和8 wk对RE内镜有效率和愈合率差异明显(4 wk:88.8%vs 59.3%,80.0%vs 51.9%;8 wk:96.0%vs 70.4%,88.0%vs 63.1%,均P<0.05),埃索美拉唑组患者活力和社会功能疗效明显(92.5±5.7 vs 85.3±7.1,85.2±4.6 vs 76.8±6.5,均P<0.05).结论:标准剂量的埃索美拉唑较加倍剂量的奥美拉唑更有效的控制GERD患者(尤其是RE患者)的临床症状,改善活力和社会功能相关的生活质量.

胃食管反流病患者生活质量调查187例

目的:调查消化门诊人群胃食管反流病(gastroesophageal reflux disease,GERD)生活质量状况.方法:针对安徽铜陵三家市级医院2008-06/08消化内科门诊连续就诊人群,根据国内通用的GERD临床诊断标准(RDQ总积分≥12分)和洛杉矶反流性食管炎(RE)内镜诊断标准进行GERD调查和诊断.采用中文版SF-36生存质量量表进行GERD患者生活质量状况地评估.所有调查资料使用Epi Data3.0软件建立数据库,利用SPSS13.0做统计学分析.根据数据的分布特征,分别采用χ2检验、非参数检验、两样本t检验.结果:三家市级医院消化内科门诊7352例连续就诊患者中共调查诊断出GERD199例.187例GERD患者实际参与了生活质量状况的调查,选取了374例同年龄同性别的正常健康人群进行了病例对照研究.结果显示,GERD病例组8个纬度生活质量评分、SF-36量表总分均明显低于健康对照组,有显著性差异(P<0.05).非糜烂性反流病(nonerosive reflux disease,NERD)组7个纬度生活质量评分、SF-36量表总分均明显低于反流性食管炎(reflux esophagitis,RE)组患者,有显著性差异(P<0.05).无论NERD或RE组女性患者生活质量量表总分均明显低于男性,有显著性差异(P<0.05).结论:GERD患者生活质量较正常健康人群明显下降;在NERD、女性患者中更为突出.精神心理因素可能在GERD发病中起到一定作用.

通降颗粒干预非糜烂性反流病肝胃不和证疗效观察

目的观察通降颗粒干预非糜烂性反流病(non-erosive reflux disease,NERD)肝胃不和证疗效。方法选择128例2009年2月—2010年11月中国中医科学院西苑医院消化科门诊及住院NERD肝胃不和证患者。采用区组随机的方法,按1∶1将患者随机分为试验组及对照组,每组64例。试验组予以通降颗粒10g/次,3次/日;对照组予以奥美拉唑肠溶片20mg,2次/日;疗程均为4周。观察指标采用症状量表和SF-36生活质量量表。结果试验完成病例114例。两组治疗前胃脘嘈杂、咽部异物感、腹部胀满或腹痛、大便积分比较,差异有统计学意义(P<0.05),其余各指标比较,差异无统计学意义(P>0.05)。与本组治疗前比较,两组各症状积分及症状总积分均有改善(P<0.01,P<0.05)。试验组除精神健康评分无统计学差异(P>0.05)外,其余各维度评分比较,差异均有统计学意义(P<0.01,P<0.05),对照组除生理功能评分无统计学差异(P>0.05)外,其余各维度评分比较,差异均有统计学意义(P<0.01,P<0.05)。两组治疗后反酸、情志烦躁和抑郁积分、身体疼痛、情感职能评分比较,差异有统计学意义(P<0.01,P<0.05)。试验组总有效率高于对照组,差异无统计学意义(P>0.05)。结论通降颗粒治疗NERD肝胃不和证疗效确切,同时可以提高患者的生活质量,未见明显不良反应。

SF-36量表在胃食管反流病患者生存质量评价中的应用

目的探讨SF-36量表在胃食管反流病(GERD)患者相关生存质量评价中的应用价值。方法121例门诊GERD患者为对象,以SF-36生活质量调查量表为工具,通过问卷调查的形式分析GERD患者的流行病学情况,分析治疗前后患者生活质量的改善情况。结果SF-36量表有良好的信度,各维度的重测信度良好,分半信度为0.93,内部一致性信度的Cronbach'sα系数均在0.700以上;治疗后SF-36生活质量量表的各个指标均有改善,以生理功能和躯体疼痛改善最为明显,其次为生理职能、总体健康、情感职能、心理健康和社会功能(P<0.05,P<0.01),但是活力因子差异无统计学意义(P>0.05)。结论用SF-36生活质量量表可以较准确地评估GERD患者的生活质量状况。

心理社会因素在非糜烂性反流病发病中作用的研究

背景:心理社会因素在功能性胃肠病中起重要作用,但在非糜烂性反流病(NERD)中的作用尚不明确。目的:探讨心理社会因素在NERD发病中的作用。方法:对在消化专科门诊就诊的有烧心、胸骨后疼痛、反酸和反食等症状的病例,行胃镜和24 h食管pH监测等检查。对NERD进行分组,并对病理性酸反流组(n=49)、生理性酸反流组(n=50) 和对照组(n=99)进行心理学评估。评估采用症状自评量表(SCL-90)、Beck抑郁自评量表、状态-特质焦虑问卷(STAI) 等量表。结果:SCL-90评估显示NERD患者的躯体化、强迫、人际关系、抑郁、焦虑、敌对、偏执等因子分和总症状分均显著高于对照组(P<0．05);NERD患者病理性酸反流组的躯体化、人际关系、焦虑、偏执等因子分和总症状分均显著高于生理性酸反流组(P<0．05),而强迫、抑郁、敌对、恐怖、精神病性等因子分,则两组间差异无显著性(P>0．05); NERD患者的状态焦虑量表(SAI)评分显著高于对照组(P<0．01),而Beck抑郁自评量表、特质焦虑量表评分与对照组的差异无显著性(P>0．05);病理性酸反流组的状态焦虑量表(SAI)评分高于生理性酸反流组(P<0．01)。结论:心理社会因素在NERD的症状产生中可能有一定的作用;病理性酸反流组的心理异常较生理性酸反流组更为明显。

旋覆代赭汤加味治疗肝胃不和型难治性胃食管反流病的临床疗效及对胃肠激素的影响

目的观察旋覆代赭汤加味治疗肝胃不和型难治性胃食管反流病(GERD)的临床疗效以及对心理状态、生活质量、血浆中胃肠激素水平的影响,探讨难治性GERD的中医临床治疗方法。方法选取该院2017年10月—2019年1月收治并自愿加入本研究符合肝胃不和辨证分型的难治性GERD患者80例,采用随机数字表法分为中医治疗组和西药治疗对照组,每组40例。西药治疗对照组采用新一代PPIs药物-埃索美拉唑联合促胃肠动力药莫沙必利,中医治疗组以旋覆代赭汤为基本方加味进行治疗。所有患者均连续治疗4周,比较两组临床症状的减轻程度;采用匹兹堡睡眠质量指数(PSQI)问卷、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)分别评价两组患者治疗前后睡眠、焦虑、抑郁情况;胃镜检查进行GERD分类诊断;酶联免疫吸附法(ELISA)检测治疗前后血浆胃泌素(gastrin,GAS)、胃动素(motilin,MTL)、胆囊收缩素(cholecystokinin,CCK)以及血管活性肠肽(vasoactive intestinal peptide,VIP)水平。结果中医治疗组总有效率高于西药治疗对照组(P<0.05);中医治疗组PSQI总分、HAMA、HAMD评分均显著低于西药治疗对照组(P<0.05);胃镜下GERD分类情况两组无显著差异。治疗前两组患者血浆4种胃肠激素水平比较无统计学意义。治疗后中医治疗组GAS、MTL水平较本组治疗前显著升高(P<0.01),而CCK、VIP水平较治疗前显著降低(P<0.01)。西药对照组治疗前后除GAS、MTL水平较本组治疗前显著升高(P<0.01)外,CCK、VIP水平治疗前后差异无显著性。结论加味旋覆代赭汤能显著减轻肝胃不合型难治性GERD患者消化道临床症状及心理状态、生活质量,其机制可能与调节胃肠激素水平,改善胃肠道功能有关。