根据在佛罗里达州举行的2010年NMA（National Medical Association）年会及科学大会上发表的试验结果，兰索拉唑可以有效治疗频繁夜间胃灼热，并可以安全的作为OTC药物。这是第一项评估用质子泵抑制剂治疗夜间发作的胃灼热效果的文章，...根据在佛罗里达州举行的2010年NMA（National Medical Association）年会及科学大会上发表的试验结果，兰索拉唑可以有效治疗频繁夜间胃灼热，并可以安全的作为OTC药物。这是第一项评估用质子泵抑制剂治疗夜间发作的胃灼热效果的文章，该研究和年会均受到诺华公司赞助。展开更多
Background: Although the wireless Bravo pH system is effective, some patients experience retrosternal sensations possibly caused by esophageal sensitivity that may complicate clinical application. Methods: Ambulatory ...Background: Although the wireless Bravo pH system is effective, some patients experience retrosternal sensations possibly caused by esophageal sensitivity that may complicate clinical application. Methods: Ambulatory pH of 40 consecutive patients with GERD who had erosive esophagitis or nonerosive reflux disease, were monitored for 2 days with the Bravo system. Results were stratified and compared on the basis of self-awareness of the intraesophageal capsule. Results: Path ologic acid reflux was diagnosed in 20 patients and normal reflux was diagnosed in 20 patients. Seventeen patients (42.5%) reported retrosternal discomfort, and 12 of them (70.6%) had normal reflux. Patients with retrosternal discomfort were less likely to have moderate endoscopic esophagitis, i.e., Los Angeles classification grades B, C, and D endoscopic esophagitis (p = 0.006), and were less likely to have significantly elevated esophageal acid exposure (p = 0.0036) than those who did not perceive the discomfort. Reported discomfort was not associated with age, gender, or the presence of endoscopic esophagitis. Conclusions: The negative correlation between Bravo-capsule-induced retrosternal discomfort and esophageal-acid exposure indicates modified mechanical afferent nerve function after long-term acid stimulation. Capsule-induced retrosternal discomfort in the presence of normal acid exposure suggests functional heartburn.展开更多
Patients with nonerosive gastroesophageal reflux disease often have relatively low esophageal acid exposure and respond suboptimally to gastric acid suppressi on. In these patients, other constituents of gastric conte...Patients with nonerosive gastroesophageal reflux disease often have relatively low esophageal acid exposure and respond suboptimally to gastric acid suppressi on. In these patients, other constituents of gastric contents may induce esophag eal symptoms.We have demonstrated that gastric contents can cause heartburn when the gastric pH > 4. (Aliment Pharm Ther 14:129-134, 2000). The aim of this stu dy was to determine relative sensitivities to chenodeoxycholic and ursodeoxychol ic acids, and 0.1 N HCl, administered as provocative perfusion tests. Patients w ith functional heartburn and healthy control subjects were evaluated. Patients u nderwent a modified Bernstein acid infusion test and esophageal Barostat balloon distention. Time and volume to pain were recorded. Barostat balloon distention was performed using our standard protocol.Step- wise distentions were performed and pain was recorded.Sensitivity to chenodeox ycholic acid (Cheno) and Ursodeoxycholic acid (Urso) were assessed similarly to the Bernstein test using 2 mM concentrations of each, followed immediately by 5 mM if no pain was reported with 2 mM. Volume of bile acid infusion and length of time until pain was induced were assessed and compared to the same endpoints fo r acid sensitivity. “Total"time and “total" volume to induce pain were calcula ted for Cheno and Urso. Least-squares means were generated and twotailed t-tes ts and regression analyses were performed (P< 0.05 l- evel of significance). Ten functional heartburn patients and six healthy contr ols were evaluated (3M, 13 F; age range, 19 to 56 years). Since five of six cont rols had pain with ac- id infusion(hypersensitive), all subjects were analyzed as one group. Only thr ee subjects (all controls) had no pain with infusion of 2 mM Cheno and received the follow-up infusion of 5 mM. These same three subjects tolerated the maximum infusion (150 ml and 15 min) of 5 mM Cheno. Nine subjects did not have pain wit h 2 mM Urso and received the follow-up infusion of 5 mM Urso(five functional he artburn, four controls). Significantly moresubjects tolerated the maximum bile a cid infusion of 2 mM Urso vs 2 mM Cheno (nine vs three; P< 0.05, Chi-square tes t).T- he pain threshold (volume and time) for Urso was significantly higher than tha t for Cheno and acid (P< 0.05), and the pain threshold for Cheno was significant ly higher than that for acid(P< 0.05). Conclusions are as follows: (1) Bile acids differ in their ability to induce pain. (2) Changing bile acid composition by treatment with Urso may change symptom presentation and symptom s everity in patients with bile acid-induced esophageal pain.展开更多
Background and aim: It is not known why some reflux episodes evoke symptoms and others do not. We investigated the determinants of perception of gastro-oesophageal reflux. Methods: In 32 patients with symptoms suggest...Background and aim: It is not known why some reflux episodes evoke symptoms and others do not. We investigated the determinants of perception of gastro-oesophageal reflux. Methods: In 32 patients with symptoms suggestive of gastro-oesophageal reflux, 24 hour ambulatory pH and impedance monitoring was performed after cessation of acid suppressive therapy. In the 20 patients who had at least one symptomatic reflux episode, characteristics of symptomatic and asymptomatic reflux episodes were compared. Results: A total of 1807 reflux episodes were detected, 203 of which were symptomatic. Compared with asymptomatic episodes, symptomatic episodes were associated with a larger pH drop (p < 0.001), lower nadir pH (p < 0.05), and higher proximal extent (p < 0.005). Symptomatic reflux episodes had a longer volume and acid clearance time (p < 0.05 and p < 0.002). Symptomatic episodes were preceded by a higher oesophageal cumulative acid exposure time (p < 0.05). The proximal extent of episodes preceding regurgitation was larger than those preceding heartburn; 14.8% of the symptomatic reflux episodes were weakly acidic. In total, 426 pure gas reflux episodes occurred, of which 12 were symptomatic. Symptomatic pure gas reflux was more frequently accompanied by a pH drop than asymptomatic gas reflux (p < 0.05). Conclusions: Heartburn and regurgitation are more likely to be evoked when the pH drop is large, proximal extent of the refluxate is high, and volume and acid clearance is delayed. Sensitisation of the oesophagus occurs by preceding acid exposure. Weakly acidic reflux is responsible for only a minority of symptoms in patients off therapy. Pure gas reflux associated with a pH drop (“ acid vapour” ) can be perceived as heartburn and regurgitation.展开更多
文摘Background: Although the wireless Bravo pH system is effective, some patients experience retrosternal sensations possibly caused by esophageal sensitivity that may complicate clinical application. Methods: Ambulatory pH of 40 consecutive patients with GERD who had erosive esophagitis or nonerosive reflux disease, were monitored for 2 days with the Bravo system. Results were stratified and compared on the basis of self-awareness of the intraesophageal capsule. Results: Path ologic acid reflux was diagnosed in 20 patients and normal reflux was diagnosed in 20 patients. Seventeen patients (42.5%) reported retrosternal discomfort, and 12 of them (70.6%) had normal reflux. Patients with retrosternal discomfort were less likely to have moderate endoscopic esophagitis, i.e., Los Angeles classification grades B, C, and D endoscopic esophagitis (p = 0.006), and were less likely to have significantly elevated esophageal acid exposure (p = 0.0036) than those who did not perceive the discomfort. Reported discomfort was not associated with age, gender, or the presence of endoscopic esophagitis. Conclusions: The negative correlation between Bravo-capsule-induced retrosternal discomfort and esophageal-acid exposure indicates modified mechanical afferent nerve function after long-term acid stimulation. Capsule-induced retrosternal discomfort in the presence of normal acid exposure suggests functional heartburn.
文摘Patients with nonerosive gastroesophageal reflux disease often have relatively low esophageal acid exposure and respond suboptimally to gastric acid suppressi on. In these patients, other constituents of gastric contents may induce esophag eal symptoms.We have demonstrated that gastric contents can cause heartburn when the gastric pH > 4. (Aliment Pharm Ther 14:129-134, 2000). The aim of this stu dy was to determine relative sensitivities to chenodeoxycholic and ursodeoxychol ic acids, and 0.1 N HCl, administered as provocative perfusion tests. Patients w ith functional heartburn and healthy control subjects were evaluated. Patients u nderwent a modified Bernstein acid infusion test and esophageal Barostat balloon distention. Time and volume to pain were recorded. Barostat balloon distention was performed using our standard protocol.Step- wise distentions were performed and pain was recorded.Sensitivity to chenodeox ycholic acid (Cheno) and Ursodeoxycholic acid (Urso) were assessed similarly to the Bernstein test using 2 mM concentrations of each, followed immediately by 5 mM if no pain was reported with 2 mM. Volume of bile acid infusion and length of time until pain was induced were assessed and compared to the same endpoints fo r acid sensitivity. “Total"time and “total" volume to induce pain were calcula ted for Cheno and Urso. Least-squares means were generated and twotailed t-tes ts and regression analyses were performed (P< 0.05 l- evel of significance). Ten functional heartburn patients and six healthy contr ols were evaluated (3M, 13 F; age range, 19 to 56 years). Since five of six cont rols had pain with ac- id infusion(hypersensitive), all subjects were analyzed as one group. Only thr ee subjects (all controls) had no pain with infusion of 2 mM Cheno and received the follow-up infusion of 5 mM. These same three subjects tolerated the maximum infusion (150 ml and 15 min) of 5 mM Cheno. Nine subjects did not have pain wit h 2 mM Urso and received the follow-up infusion of 5 mM Urso(five functional he artburn, four controls). Significantly moresubjects tolerated the maximum bile a cid infusion of 2 mM Urso vs 2 mM Cheno (nine vs three; P< 0.05, Chi-square tes t).T- he pain threshold (volume and time) for Urso was significantly higher than tha t for Cheno and acid (P< 0.05), and the pain threshold for Cheno was significant ly higher than that for acid(P< 0.05). Conclusions are as follows: (1) Bile acids differ in their ability to induce pain. (2) Changing bile acid composition by treatment with Urso may change symptom presentation and symptom s everity in patients with bile acid-induced esophageal pain.
文摘Background and aim: It is not known why some reflux episodes evoke symptoms and others do not. We investigated the determinants of perception of gastro-oesophageal reflux. Methods: In 32 patients with symptoms suggestive of gastro-oesophageal reflux, 24 hour ambulatory pH and impedance monitoring was performed after cessation of acid suppressive therapy. In the 20 patients who had at least one symptomatic reflux episode, characteristics of symptomatic and asymptomatic reflux episodes were compared. Results: A total of 1807 reflux episodes were detected, 203 of which were symptomatic. Compared with asymptomatic episodes, symptomatic episodes were associated with a larger pH drop (p < 0.001), lower nadir pH (p < 0.05), and higher proximal extent (p < 0.005). Symptomatic reflux episodes had a longer volume and acid clearance time (p < 0.05 and p < 0.002). Symptomatic episodes were preceded by a higher oesophageal cumulative acid exposure time (p < 0.05). The proximal extent of episodes preceding regurgitation was larger than those preceding heartburn; 14.8% of the symptomatic reflux episodes were weakly acidic. In total, 426 pure gas reflux episodes occurred, of which 12 were symptomatic. Symptomatic pure gas reflux was more frequently accompanied by a pH drop than asymptomatic gas reflux (p < 0.05). Conclusions: Heartburn and regurgitation are more likely to be evoked when the pH drop is large, proximal extent of the refluxate is high, and volume and acid clearance is delayed. Sensitisation of the oesophagus occurs by preceding acid exposure. Weakly acidic reflux is responsible for only a minority of symptoms in patients off therapy. Pure gas reflux associated with a pH drop (“ acid vapour” ) can be perceived as heartburn and regurgitation.
