北京积水潭医院精品课件——胃食管反流.pptVIP

* * * H2受体拮抗剂通过抑制壁细胞基底膜H2受体上的组胺发挥作用，降低壁细胞的活性，但不能完全停止H+的分泌，因为胃泌素和乙酰胆碱受体仍然是有活性的(1)。 H2受体拮抗剂包括雷尼替丁，西米替丁，法莫替丁和尼扎替丁(4) 。 1 Sachs G, Shin J M, Briving C, et al. The pharmacology of the gastric acid pump: The H+, K+-ATPase. Annu Rev Pharmacol Toxicol 1995; 25: 277-305. * * Omeprazole is superior to the H2-receptor antagonists in healing reflux oesophagitis across all grades of disease Omeprazole is consistently superior to the H2-receptor antagonists in healing reflux oesophagitis, irrespective of the severity of the oesophagitis. In a randomized, double-blind trial involving patients with reflux oesophagitis, the healing rates with omeprazole, 20 mg once daily, were superior to the rates with cimetidine, 400 mg four times d a i l y, after both 4 and 8 weeks of treatment for all grades of the disease17. Additionally, the severity of disease had no effect on the high healing rates achieved with omeprazole, but the healing rate with the H2-receptor antagonist progressively decreased with increasing severity of oesophagitis. There was no correlation between the severity of heartburn, which was the predominant symptom at entry, and the severity of oesophagitis. However, resolution of heartburn with omeprazole was superior to that with cimetidine across all patients at both 4 and 8 weeks. This study is consistent with numerous others, which demonstrate that omeprazole, 20 mg once daily, is an appropriate first-line therapy for the acute treatment of reflux oesophagitis, providing symptom resolution and reliable healing in virtually all patients. Additionally, numerous studies have shown omeprazole, 20?0 mg once daily, to be highly effective in the treatment of poorly responsive reflux oesophagitis, which has failed to heal after high-dose or prolonged treatment with H2-receptor antagonists3. 病理性胃食管反流的治疗对策 改变生活方式 避免过饱、油腻、忌烟酒 避免药物引起的GER 硝酸甘油、Ca++A、茶碱等 抗反流药物 抑酸剂(H2RA, PPI) 促动力剂，TLESR抑制剂（GABA 激动剂 baclofen)、 CCK拮抗 剂（氯谷胺）