| GERD( gastroesophaged reflux disease) is a disease that caused by the reflux of the mixed material in stomach and duodenum which manifests a serial of chronic symptoms and characterized pathologically by damage of membrane of esophagus. Because it is a kind of chronic disease which has a high incidence and is apt to relapse, it's long term curative effect is not satisfied. Nowadays, it's treatment project of initial stage is definitive, that is, to treat in increase project or decrease project based on severity. But how to treat in maintain stage is still not come to a consensus and it is difficult to definite a period of treatment. When patients accepted medicine continuously for 2~4 months, there were half and more patients relapsed after 6 months. Doctors tried hard to last effective time by prolonging dose time, but it often accompanied by many disadvantages. With the etiological mechanism research of GERD, now it has been elucidated that GERD includes three subtypes, ie, NERD(non-erosive reflux disease), erosive GERD(refluxed oesophagitis, RE)and Barrett oesophagus. They are three independent pathogenic course and are not apt to transform. Emphases of treating GERD should be control symptoms other than membrane concrescence of oesophagus and on-demand project should be applied. Because on-demand project is easy to apply and can appear prominent effect in shorter time and can last longer time and can relax patients promptly, when the new generation of PPI(proton pump inhibitor)invented, it made on-demand project possible. Rabeprazole, for it's unique advantage, was used extensively.Though PPIs is better in treating acid-related disorders comparing to previously acid inhibitors and H2—receptor inhibitors, the first generation of PPIs has some obvious limitation, behaving as slowly effect and non-lasting acid inhibition and individual difference, so often affected by intrahepatic metabolism and cannot act stably. But Rabeprazole, one of the new generation PPIs, has a predominance on pharmacodynamics and pharmacokinetics, manifested a notable difference in curative effect and in economics. It activate faster than others and can combine with more targets and metabolize trans non-enzyme system, so it has a low first-pass elimination and has no drug cumulation, then can affect patients promptly and lead to a long term action. Now Rabeprazole is considered a kind of ideal efficient and safety PPI on treating acid-related disorderss.In order to compare the clinical effect and practicability of Rabeprazole when applied to erosive GERD in on-demand way with in general keeping way, 50 RE patients at digestive department clinic from Oct. 2002 to Jun. 2003 were included in our study.Material and methods 50 erosive GERD patients are admitted. According to the symptomatic score, endoscopic results and previous medical curative effect, after PPI or H2-receptor inhibitor applied 2 months in different treatment projects, we made patients randomly into general treatment group and on-demand treatment group. There was no significant difference between them on body condition. Patients in general group continued previous medical treatment for 2 months then ceased. Patients in on-demand group continued to use Rabeprazole. All patients were observed for 6 months.Results There was no significant difference on symptomatic score between 2 groups at 4th month (P>0.05). Symptomatic score of on-demand group is significantly better than that of general group (P<0.05), but there was no significant difference compared to that of the 4th month(P>0.05). Symptomatic score of 2 groups reduced 62.2% and 31.6% respectively at 6th month. There was significant difference between 2 groups on endoscopic result (P<0.05), two groups were obviously better than that of before treatment (P<0.05).Average dosage of Rabeprazole was 37.5 tablets, that is, 1 tablet in 3.2 days. The ratio of time of accepting drugs is 31% in on-demand group. There were 12.0% patients occurred side-effect in general group, where as 8.0%... |
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