关键词:

难治性胃食管反流病, 艾司奥美拉唑, 双倍剂量, 莫沙必利, 坦度螺酮, 生长激 素释放肽, 瘦素, 胃蛋白酶原Ⅰ

Abstract:

Objective To explore the efficacy of double⁃dose esomeprazole and mosapride combined with tandospirone in the treatment of refractory gastroesophageal reflux disease（rGERD）. Methods One hundred and forty⁃six patients with rGERD were randomly divided into control group（double⁃dose esomeprazole + mosapride） and treatment group（double ⁃ dose esomeprazole + mosapride + tandospirone），with seventy ⁃ three cases each group. The differences in clinical symptom score，endoscopic mucosal grading，total therapeutic response，SAS score，SDS score，SF⁃36 score，esophageal dynamics indexes and serological indexes were compared between the two groups. The adverse reactions of the two groups were recorded，and the recurrence rate of the patients with effective treatment was followed up for half a year. Results Before treatment，clinical symptom scores，grade of endoscopic mucosa，SAS scores and SDS scores，SF⁃36 scale，esophageal sphincter pressure，stand reflux time ratio，decubitus reflux time ratio，total reflux ratio and the serum levels of growth hormone releasing peptide（ghre⁃ lin），leptin，pepsinogen Ⅰ（PG Ⅰ）were no statistical differences（P > 0.05）between the two groups，after treat⁃ ment，clinical symptom scores，grade of endoscopic mucosa，SAS scores，SDS scores，stand reflux time ratio， decubitus reflux time ratio，total reflux ratio and the levels of leptin，PG I decreased（P < 0.05），SF⁃36 scale， esophageal sphincter pressure，ghrelin level increased（P < 0.05）in the two groups，but the improvement of the above indexes of treatment group were better than the control group（P < 0.05）. The total effective rate of treatment in the treatment group was higher than that in the control group（91.78% vs. 79.45%，P < 0.05）. Clinical symptom score and endoscopic mucosal grade after tandospireone treatment were positively correlated with SAS score and SDS score after treatment（P < 0.05）. In the treatment process，both groups had individual cases of dizziness， fatigue and other minor adverse reactions，which did not affect the treatment.After six months of follow⁃up，the recurrence rate in the treatment group［43.3%（29/67）］was lower than that in the control group［77.6%（45/58）］ （P < 0.05）. Conclusion Compared with the double dose of esomeprazole combined with mosabil，the double dose of esomeprazole combined with mosapride combined with tandospirone was more effective in the treatment of rGERD.

Key words:

refractory gastroesophageal reflux disease, esomeprazole, double ? dose, mosapride, dandospirone, ghrelin, leptin, pepsinogen Ⅰ