Clinical trial: acupuncture vs. doubling the proton pump inhibitor dose in refractory heartburn
Clinical trial: acupuncture vs. doubling the proton pump inhibitor dose in refractory heartburn
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DOI：
10.1111/j.1365-2036.2007.03520.x
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发表时间：
2007-11-15
影响因子：
7.6
通讯作者：
Fass, R.
中科院分区：
文献类型：
--
作者：
Dickman, R.;Schiff, E.;Fass, R.
背景目前治疗质子泵抑制剂失败的标准是加倍质子泵抑制剂的剂量，尽管治疗效果有限。目的探讨每日1次质子泵抑制剂治疗无效的胃食管反流病患者，针刺治疗与质子泵抑制剂剂量加倍治疗的疗效。方法选取30例经标准剂量质子泵抑制剂治疗后仍有症状的经典胃灼热患者作为研究对象。所有的参与者在服用质子泵抑制剂时每天进行一次上内窥镜检查。随后，患者被随机分配到在质子泵抑制剂的基础上增加针灸治疗，或者在4周内将质子泵抑制剂的剂量增加一倍。针灸每周由专家进行两次。结果两组在人口学参数上无差异。与基线相比，针灸+质子泵抑制剂组在治疗结束时的平均日间胃灼热、夜间胃灼热和胃酸倒流评分显著降低，而双剂量质子泵抑制剂组在其临床终点未显示显着变化。平均一般健康评分仅在针灸+质子泵抑制剂组有显著改善。结论在标准剂量质子泵抑制剂治疗失败的患者中，增加针灸治疗比增加质子泵抑制剂剂量更能有效地控制胃食管反流病相关症状。
Background The current standard of care in proton pump inhibitor failure is to double the proton pump inhibitor dose, despite limited therapeutic gain.Aims To determine the efficacy of adding acupuncture vs. doubling the proton pump inhibitor dose in gastro-oesophageal reflux disease patients who failed symptomatically on proton pump inhibitors once daily.Methods Thirty patients with classic heartburn symptoms who continued to be symptomatic on standard-dose proton pump inhibitors were enrolled into the study. All participants underwent upper endoscopy while on proton pump inhibitors once daily. Subsequently, patients were randomized to either adding acupuncture to their proton pump inhibitor or doubling the proton pump inhibitor dose over a period of 4 weeks. Acupuncture was delivered twice a week by an expert.Results The two groups did not differ in demographic parameters. The acupuncture + proton pump inhibitor group demonstrated a significant decrease in the mean daytime heartburn, night-time heartburn and acid regurgitation scores at the end of treatment when compared with baseline, while the double-dose proton pump inhibitor group did not demonstrate a significant change in their clinical endpoints. Mean general health score was only significantly improved in the acupuncture + proton pump inhibitor group.Conclusion Adding acupuncture is more effective than doubling the proton pump inhibitor dose in controlling gastro-oesophageal reflux disease-related symptoms in patients who failed standard-dose proton pump inhibitors.