We evaluated the efficacy and tolerability of a dual therapy with rabeprazole and amoxicillin (AMX) as an empiric third-line rescue therapy. In patients with failure of first-line treatment with a proton pump inhibito...We evaluated the efficacy and tolerability of a dual therapy with rabeprazole and amoxicillin (AMX) as an empiric third-line rescue therapy. In patients with failure of first-line treatment with a proton pump inhibitor (PPI)- AMX-clarithromycin regimen and second-line treatment with the PPI-AMX-metronidazole regimen, a third-line eradication regimen with rabeprazole (10 mg q.i.d.) and AMX (500 mg q.i.d.) was prescribed for 2 wk. Eradication was confirmed by the results of the 13C-urea breath test (UBT) at 12 wk after the therapy. A total of 46 patients were included; however, two were lost to followup. The eradication rates as determined by per-protocol and intention-to-treat analyses were 65.9% and 63.0%,respectively. The pretreatment UBT results in the subjects showing eradication failure; those patients showing successful eradication comprised 32.9 ± 28.8 permil and 14.8 ± 12.8 permil, respectively. The pretreatment UBT results in the subjects with eradication failure were significantly higher than those in the patients with successful eradication (P = 0.019). A low pretreatment UBT result (≤ 28.5 permil) predicted the success of the eradication therapy with a positive predictive value of 81.3% and a sensitivity of 89.7%. Adverse effects were reported in 18.2% of the patients, mainly diarrhea and stomatitis. Dual therapy with rabeprazole and AMX appears to serve as a potential empirical third-line strategy for patients with low values on pretreatment UBT.展开更多
AIM:To investigate the prevalence of gastroesophageal reflux disease(GERD) in patients with a laryngoscopic diagnosis of laryngopharyngeal reflux(LPR).METHODS:Between May 2011 and October 2011,41 consecutive patients ...AIM:To investigate the prevalence of gastroesophageal reflux disease(GERD) in patients with a laryngoscopic diagnosis of laryngopharyngeal reflux(LPR).METHODS:Between May 2011 and October 2011,41 consecutive patients with laryngopharyngeal symptoms(LPS) and laryngoscopic diagnosis of LPR were empirically treated with proton pump inhibitors(PPIs) for at least 8 wk,and the therapeutic outcome was assessed through validated questionnaires(GERD impact scale,GIS;visual analogue scale,VAS).LPR diagnosis was performed by ear,nose and throat specialists using the reflux finding score(RFS) and reflux symptom index(RSI).After a 16-d wash-out from PPIs,all patients underwent an upper endoscopy,stationary esophageal manometry,24-h multichannel intraluminal impedance and pH(MII-pH) esophageal monitoring.A positive correlation between LPR diagnosis and GERD was supposed based on the presence of esophagitis(ERD),pathological acid exposure time(AET) in the absence of esophageal erosions(NERD),and a positive correlation between symptoms and refluxes(hypersensitive esophagus,HE).RESULTS:The male/female ratio was 0.52(14/27),the mean age ± SD was 51.5 ± 12.7 years,and the mean body mass index was 25.7 ± 3.4 kg/m 2.All subjects reported one or more LPS.Twenty-five out of 41 patients also had typical GERD symptoms(heartburn and/or regurgitation).The most frequent laryngoscopic findings were posterior laryngeal hyperemia(38/41),linear indentation in the medial edge of the vocal fold(31/41),vocal fold nodules(6/41) and diffuse infraglottic oedema(25/41).The GIS analysis showed that 10/41 patients reported symptom relief with PPI therapy(P < 0.05);conversely,23/41 did not report any clinical improvement.At the same time,the VAS analysis showed a significant reduction in typical GERD symptoms after PPI therapy(P < 0.001).A significant reduction in LPS symptoms.On the other hand,such result was not recorded for LPS.Esophagitis was detected in 2/41 patients,and ineffective esophageal motility was found in 3/41 patients.The MII-pH analysis showed an abnormal AET in 5/41 patients(2 ERD and 3 NERD);11/41 patients had a normal AET and a positive association between symptoms and refluxes(HE),and 25/41 patients had a normal AET and a negative association between symptoms and refluxes(no GERD patients).It is noteworthy that HE patients had a positive association with typical GERD-related symptoms.Gas refluxes were found more frequently in patients with globus(29.7 ± 3.6) and hoarseness(21.5 ± 7.4) than in patients with heartburn or regurgitation(7.8 ± 6.2).Gas refluxes were positively associated with extraesophageal symptoms(P < 0.05).Overall,no differences were found among the three groups of patients in terms of the frequency of laryngeal signs.The proximal reflux was abnormal in patients with ERD/NERD only.The differences observed by means of MII-pH analysis among the three subgroups of patients(ERD/NERD,HE,no GERD) were not demonstrated with the RSI and RFS.Moreover,only the number of gas refluxes was found to have a significant association with the RFS(P = 0.028 andP = 0.026,nominal and numerical correlation,respectively).CONCLUSION:MII-pH analysis confirmed GERD diagnosis in less than 40% of patients with previous diagnosis of LPR,most likely because of the low specificity of the laryngoscopic findings.展开更多
基金Supported by A grant from the National Hospital Organization,No. H21-NHO-01
文摘We evaluated the efficacy and tolerability of a dual therapy with rabeprazole and amoxicillin (AMX) as an empiric third-line rescue therapy. In patients with failure of first-line treatment with a proton pump inhibitor (PPI)- AMX-clarithromycin regimen and second-line treatment with the PPI-AMX-metronidazole regimen, a third-line eradication regimen with rabeprazole (10 mg q.i.d.) and AMX (500 mg q.i.d.) was prescribed for 2 wk. Eradication was confirmed by the results of the 13C-urea breath test (UBT) at 12 wk after the therapy. A total of 46 patients were included; however, two were lost to followup. The eradication rates as determined by per-protocol and intention-to-treat analyses were 65.9% and 63.0%,respectively. The pretreatment UBT results in the subjects showing eradication failure; those patients showing successful eradication comprised 32.9 ± 28.8 permil and 14.8 ± 12.8 permil, respectively. The pretreatment UBT results in the subjects with eradication failure were significantly higher than those in the patients with successful eradication (P = 0.019). A low pretreatment UBT result (≤ 28.5 permil) predicted the success of the eradication therapy with a positive predictive value of 81.3% and a sensitivity of 89.7%. Adverse effects were reported in 18.2% of the patients, mainly diarrhea and stomatitis. Dual therapy with rabeprazole and AMX appears to serve as a potential empirical third-line strategy for patients with low values on pretreatment UBT.
文摘AIM:To investigate the prevalence of gastroesophageal reflux disease(GERD) in patients with a laryngoscopic diagnosis of laryngopharyngeal reflux(LPR).METHODS:Between May 2011 and October 2011,41 consecutive patients with laryngopharyngeal symptoms(LPS) and laryngoscopic diagnosis of LPR were empirically treated with proton pump inhibitors(PPIs) for at least 8 wk,and the therapeutic outcome was assessed through validated questionnaires(GERD impact scale,GIS;visual analogue scale,VAS).LPR diagnosis was performed by ear,nose and throat specialists using the reflux finding score(RFS) and reflux symptom index(RSI).After a 16-d wash-out from PPIs,all patients underwent an upper endoscopy,stationary esophageal manometry,24-h multichannel intraluminal impedance and pH(MII-pH) esophageal monitoring.A positive correlation between LPR diagnosis and GERD was supposed based on the presence of esophagitis(ERD),pathological acid exposure time(AET) in the absence of esophageal erosions(NERD),and a positive correlation between symptoms and refluxes(hypersensitive esophagus,HE).RESULTS:The male/female ratio was 0.52(14/27),the mean age ± SD was 51.5 ± 12.7 years,and the mean body mass index was 25.7 ± 3.4 kg/m 2.All subjects reported one or more LPS.Twenty-five out of 41 patients also had typical GERD symptoms(heartburn and/or regurgitation).The most frequent laryngoscopic findings were posterior laryngeal hyperemia(38/41),linear indentation in the medial edge of the vocal fold(31/41),vocal fold nodules(6/41) and diffuse infraglottic oedema(25/41).The GIS analysis showed that 10/41 patients reported symptom relief with PPI therapy(P < 0.05);conversely,23/41 did not report any clinical improvement.At the same time,the VAS analysis showed a significant reduction in typical GERD symptoms after PPI therapy(P < 0.001).A significant reduction in LPS symptoms.On the other hand,such result was not recorded for LPS.Esophagitis was detected in 2/41 patients,and ineffective esophageal motility was found in 3/41 patients.The MII-pH analysis showed an abnormal AET in 5/41 patients(2 ERD and 3 NERD);11/41 patients had a normal AET and a positive association between symptoms and refluxes(HE),and 25/41 patients had a normal AET and a negative association between symptoms and refluxes(no GERD patients).It is noteworthy that HE patients had a positive association with typical GERD-related symptoms.Gas refluxes were found more frequently in patients with globus(29.7 ± 3.6) and hoarseness(21.5 ± 7.4) than in patients with heartburn or regurgitation(7.8 ± 6.2).Gas refluxes were positively associated with extraesophageal symptoms(P < 0.05).Overall,no differences were found among the three groups of patients in terms of the frequency of laryngeal signs.The proximal reflux was abnormal in patients with ERD/NERD only.The differences observed by means of MII-pH analysis among the three subgroups of patients(ERD/NERD,HE,no GERD) were not demonstrated with the RSI and RFS.Moreover,only the number of gas refluxes was found to have a significant association with the RFS(P = 0.028 andP = 0.026,nominal and numerical correlation,respectively).CONCLUSION:MII-pH analysis confirmed GERD diagnosis in less than 40% of patients with previous diagnosis of LPR,most likely because of the low specificity of the laryngoscopic findings.
