High dose proton pump inhibitor response as an initial strategy for a clinical diagnosis of gastro-oesophageal reflux disease (GERD). Swedish multi-centre group in primary health care.
High dose proton pump inhibitor response as an initial strategy for a clinical diagnosis of gastro-oesophageal reflux disease (GERD). Swedish multi-centre group in primary health care.
复制标题
高剂量质子泵抑制剂反应作为胃食管反流病（GERD）临床诊断的初始策略。
DOI：
10.1093/fampra/17.5.401
复制
发表时间：
2000
期刊：
影响因子：
2.2
通讯作者：
H. Sörngård
中科院分区：
文献类型：
--
作者：
J. Brun;H. Sörngård
背景
初级保健中胃食管反流病（GERD）的诊断主要取决于症状。食管酸暴露是最重要的致病因素，对酸抑制的症状反应也可能是 GERD 患者的标志。
目标
本研究的目的是评估基于症状的策略在初级保健中管理 GERD 患者的结果。
方法
主要症状为至少中度胃灼热或反流的全科患者接受奥美拉唑 20 mg b.i.d. 治疗。公开为期7天（第一阶段）。后来复发的应答者被随机分配接受奥美拉唑 20 mg o.m 的双盲治疗。或安慰剂 2 周（第二阶段）。两个阶段的反应被定义为在七级李克特量表上至少降低三个等级，并且主要症状的强度不超过轻度。
结果
在第一阶段接受评估的 362/371 名招募患者中，73% 是有反应者。第二阶段总共评估了 174/179 名复发患者，奥美拉唑组和安慰剂组分别有 74% 和 28% 被定义为有反应者（P：< 0.001，95% 置信区间 33-59）。
结论
GERD 患者对奥美拉唑 20 mg b.i.d 高度敏感。他们对奥美拉唑 20 mg o.m 的反应相同。症状复发，但对安慰剂的反应率较低。奥美拉唑是一种有价值的治疗工具，可在一般实践中检测和治疗 GERD 患者。
BACKGROUND
The diagnosis of gastro-oesophageal reflux disease (GERD) in primary care rests primarily on symptoms. Oesophageal acid exposure is the most important pathogenic factor and it is likely that symptom response to acid inhibition also identifies patients with GERD.
OBJECTIVE
The aim of this study was to evaluate the outcome of a symptom-based strategy in the management of GERD patients in primary care.
METHODS
Patients in general practice with main symptoms of at least moderate heartburn or regurgitation were given omeprazole 20 mg b.i.d. openly for 7 days (first phase). Responders with later relapse were randomized to double-blind treatment with omeprazole 20 mg o.m. or placebo for 2 weeks (second phase). A response in both phases was defined as a decrease by at least three grades on a seven-grade Likert scale and no more than mild intensity of the main symptom.
RESULTS
Of the 362/371 recruited patients who were evaluated in the first phase, 73% were responders. A total of 174/179 patients with a relapse were assessed in the second phase, and 74 and 28% in the omeprazole and placebo group, respectively, were defined as responders (P: < 0.001, 95% confidence interval 33-59).
CONCLUSIONS
GERD patients are highly responsive to omeprazole 20 mg b.i.d. They are equally responsive to omeprazole 20 mg o.m. at symptomatic relapse, but have a low response rate to placebo. Omeprazole is a valuable therapeutic instrument to detect and treat patients with GERD in general practice.