淺談胃食道逆流的藥物治療

Pharmacological Treatment for Gastro-Esophageal Reflux Disease

胃食道逆流症(Gastro-Esophageal Reflux Disease)或簡稱GERD，隨著國人飲食西化，胃食道逆流患者有日漸增多之勢，是一種相當普遍的狀況，目前台灣盛行率約14%。胃食道逆流是指胃中的內容物回流到食道或口咽部，造成病患一些不適的症狀；它的主要症狀為心灼熱感，即胸部有燒灼感，偶爾口中會有苦味。造成胃食道逆流的原因是多元性的，包括胃、胰液和膽汁逆流、食道管腔排空能力、食道上皮細胞防衛能力。而某些藥物，如抗氣喘藥、抗焦慮藥、抗高血壓藥、阿斯匹靈等，都可能誘發或加重胃食道逆流症狀。胃食道逆流除了會造成病人長期身心困擾，及醫療費用支出外，併發症除了食道發炎、潰瘍及Barrett黏膜，也是食道腺癌的癌前驅病灶。胃食道逆流疾病的治療目標，主要為症狀緩解避免併發症，以及改善生活品質。在一些輕微症狀的胃食道逆流病患上，可藉由生活形態的調整、改變飲食習慣、避免併服可能引起胃食道逆流的藥物。藥物用於治療胃食道逆流疾病最普遍的方式，即是中和胃酸或抑制胃酸分泌，保持酸鹼值在4以上可以減少胃部內容物逆流食道所造成的傷害。可使用的藥物包括制酸劑、黏膜保護劑、促腸胃蠕動劑、H2受體拮抗劑、氫離子幫浦抑制劑等，通常以下階梯式療法來運用，可獲得較佳的治療效果。除此，胃食道逆流是一種慢性疾病，所以維持療法是必須的。

With an increasingly Westernized diet in Taiwan, Gastro-Esophageal Reflux Disease (GERD) is one of the most common diagnoses in daily practice with an estimated lifetime prevalence of about 14 percent of the population. When acid reflux occurs, food or fluid can be tasted in the back of the mouth. When refluxed stomach acid touches the lining of the esophagus it may cause a burning sensation in the chest or throat called heartburn. GERD is thought to have a multifactorial etiology rather than a single cause. Contributing factors include the caustic materials that are refluxed, a breakdown in the defense mechanisms of the esophagus, a functional abnormality that results in reflux, and certain medications such as aspirin and drugs for asthma attack, depression, hypertension. Chronic GERD that is untreated can cause serious complications including esophagitis, narrowing of the esophagus, and Barrett ’s esophagus leading to esophageal cancer. Patients with GERD and its complications should be monitored closely by a physician. The goals of treatment for GERD are to relieve symptoms, prevent complications, and improve the quality of life. Cases of mild GERD can be managed with lifestyle changes and avoidance of stimulants. Acid suppressing medications continue to be the mainstay in the treatment of GERD. These include antacids, mucoprotective agents, prokinetics, H2-antagonists, and proton pump inhibitors. A step-down treatment regimen is recommended. Because the condition is chronic, maintenance therapy is necessary to prevent relapse of GERD.