联合应用巴氯芬、埃索美拉唑和莫沙必利治疗难治性胃食管反流病的疗效

摘要

背景：对常规剂量质子泵抑制剂治疗无反应的胃食管反流病（ GERD）称为难治性胃食管反流病（ rGERD），国内主要联合多种药物治疗rGERD患者，但巴氯芬的报道较少见。目的：探讨巴氯芬联合埃索美拉唑和莫沙必利治疗rGERD的疗效。方法：纳入2013年3月-2014年4月福建省莆田市第一医院72例rGERD患者，随机分为两组。A组患者口服埃索美拉唑20 mg bid +莫沙必利5 mg tid +巴氯芬5 mg tid；B组口服埃索美拉唑20 mg bid +莫沙必利5 mg tid，疗程均为8周。比较两组症状、内镜下食管炎改善情况和不良反应。结果：治疗8周后，两组烧心、反酸、胸骨后疼痛、吞咽困难、症状总计分均较治疗前显著降低（ P﹤0.05），A组症状改善总有效率显著高于 B组（90.6%对70.0%；χ2=4.585，P=0.032）。两组内镜下食管炎分级情况明显改善，A组内镜下治疗有效率显著高于B组（93.8%对75.0%；χ2=4.500，P=0.034）。巴氯芬的主要不良反应为嗜睡、头晕和乏力，患者均能耐受。结论：巴氯芬联合埃索美拉唑和莫沙必利是一种有效治疗rGERD的方法。%Background:Gastroesophageal reflux disease( GERD)that does not respond satisfactorily to standard proton pump inhibitor is defined as refractory gastroesophageal reflux disease( rGERD). Combined therapy is used to treat rGERD, however,the addition of baclofen is rarely studied. Aims:To investigate the efficacy of baclofen combined with esomeprazole and mosapride on rGERD. Methods:Seventy-two patients with rGERD from March 2013 to April 2014 at the First Hospital of Putian City were enrolled and randomly divided into group A and group B. Patients in group A were orally administrated with esomeprazole 20 mg bid + mosapride 5 mg tid + baclofen 5 mg tid. Patients in group B were treated with esomeprazole 20 mg bid + mosapride 5 mg tid. The treatment course was 8 weeks. The efficacy on symptoms, esophagitis under endoscopy and adverse effects were compared between the two groups. Results:After 8-week treatment, score of heartburn,regurgitation,retrosternal pain,dysphagia and overall symptom were significantly decreased in the two groups than before the treatment. The overall symptom alleviating rate was significantly higher in group A than in group B (90. 6% us. 70. 0%;χ2 =4. 585,P=0. 032). Esophagitis under endoscopy in the two groups was significantly improved, the effective rate was significantly higher in group A than in group B(93. 8% us. 75. 0%;χ2 =4. 500,P=0. 034). The main adverse effects of baclofen were somnolence,dizziness and fatigue,all the patients were well tolerated. Conclusions:Baclofen combined with esomeprazole and mosapride is an efficient option for rGERD.