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Background : Transient esophageal ulceration is a common finding after sclerotherapy of varices. These ulcers sometimes cause pain, ulcer bleeding, and stricture formation. Gastroesophageal reflux (GE...R) after Endoscopic injection sclerotherapy (EIS) is a known cause of worsening ulcer formation. Therefore, an efficient drug for GER is desirable to improve the quality of life of patients with esophageal varices. Methods : We randomized 18 Japanese cirrhotic patients who had risky esophageal varices. The patients were randomly allocated into two groups, and during EIS sessions, one group was administered proton pump inhibitor (PPI) (Rabeprazole 20mg a person once a day), while the other received histamine H2 receptor antagonist (H_2-blocker) (famotidine 20mg a person, twice a day). Gastroesophageal reflux was monitored by a 24-h pH-monitoring catheter introduced into the distal esophagus. Ulcer formation was evaluated using an endoscopic examination. The subjective and objective symptoms were also compared between the two groups. Results : All patients in the H_2-blocker group showed an increased percentage of time with pH < 4.0 after EIS sessions, but no patients in the PPI group showed an increased such symptoms. The H2-blocker group also experienced a significantly higher number of days of heartburn and dysphasia than did the PPI group (p = 0.017, p = 0.042). The rate of ulcer improvement was found to be faster in Rabeprazole group than in H_2 blocker group (p = 0.008). Conclusion : These results suggest that Rabeprazole treatment prevents EIS-associated gastroesophageal reflux and promotes ulcer healing. Rabeprazole also improve the subjective symptoms following EIS.
【背景】食道静脈瘤に対する内視鏡的硬化療法(EIS)後の食道潰瘍は最も認められる合併症である．食道潰瘍は，疼痛の原因となり，悪化すれば潰瘍出血と狭窄形成が起きる．胃食道逆流(GER)は，潰瘍形成を悪化させる既知の原因である．従って，GERの薬剤であるプロトンポンプ阻害剤は，治療後の患者のQOLを改善する可能性がある．【方法】我々は，易出血性食道静脈瘤が認められ，内視鏡的硬化療法を受けた18例の患者をヒスタミンH2レセプター拮抗剤(H2 受容体遮断薬)(40mg 2x/day)を治療後1週間内服する群(H2-blocker群)，またはプロトンポンプ阻害剤(PPI)(20m 1x/day)を治療後1週間内服する群(PPI群)に分け，胃食道逆流(遠位食道にもたらされる24時間のpH監視カテーテル検査)，潰瘍形成所見(上部内視鏡検査)，治療後の自覚症状について2群間で比較した．【結果】H2-blocker群では，EIS治療後，pH < 4.0で示す胃酸逆流時間は有意に増加したが，PPI群では胃酸逆流の時間は増加を認めなかった．胸やけと嚥下障害の日数はH2-blocker群に比べPPI群では有意に少なかった．(胸焼けp=0.017，嚥下障害p=0.042)．内視鏡的に評価した潰瘍改善率もPPI群で早期に認められた(p=0.008)．【結語】プロトンポンプ阻害剤であるRabeprazoleは内視鏡硬化療法後に合併する胃酸逆流による症状と潰瘍形成を改善する．続きを見る
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Mendeley出力
