The treatment goal of reflux esophagitis is mucosal healing and symptom relief, before, we introduced the "new" concept of reflux esophagitis treatment: the importance of standard treatment - mucosal healing, today we will take a look at the application of standard treatment in the relief of reflux esophagitis symptoms.
The evaluation indicators for the standard treatment of reflux esophagitis are seen as follows
24-hour PH>4HTR (proportion of 24-hour PH>4), and the patient's initial treatment of mucosal healing rate, symptom control, is also a good predictor of the initial treatment of reflux esophagitis. Studies have shown that the higher the 24-hour gastric PH>4 time, the lower the severity score of the symptoms.
It is reported that from the evaluation of mucosal healing to the relief of symptoms, the 24h gastric PH4HTR indicator can allow us to more clearly record the real situation of reflux esophagitis management, and at the same time provide more accurate information for us to effectively control the symptoms of reflux esophagitis, and also help clinicians choose a more reasonable plan.
Current status of symptom control of reflux esophagitis
The symptoms of reflux esophagitis are the main reasons for affecting patient visits.
As we all know, the typical symptoms of reflux esophagitis in the esophagus are acid reflux, heartburn, especially after meals, and are more likely to appear symptoms when lying flat. Some patients also have symptoms such as retrosternal and heart socket burning sensation.
Reflux esophagitis extraesophageal symptoms are mainly manifested as cough, asthma and laryngitis and other symptoms, there are a small number of patients whose first symptoms are not intraesophageal symptoms, but extraesophageal symptoms, especially cough and asthma caused by reflux, often paroxysmal, as well as nighttime cough and asthma.
Psychological factors in patients with reflux esophagitis are also affected, and relevant studies have found that patients with reflux esophagitis have a significant decline in quality of life compared with healthy people, and it is common to be accompanied by depression, anxiety and other mental abnormalities.
PPI's control of symptoms of reflux esophagitis is not ideal
The blue bar represents the placebo effect and the green bar represents the therapeutic gain of proton pump inhibitors beyond the placebo effect.
Why is it difficult for PPIs to achieve treatment standards?
The pharmacological properties of PPI determine its limitations in the standard treatment of reflux esophagitis.
PPI acid inhibition effect is relatively slow, and the time of the first day of PH4HTR is difficult to reach 75%, it needs to be administered every day, and the maximum acid inhibition effect can be achieved after 3-5 days.
The half-life of PPI is relatively short, especially within 0.5-2 hours, can not achieve long-lasting acid suppression, and at night the gastric PH<4 lasts longer.
In most cases, treatment with PPIBID is not possible to achieve 24-hour intragastric PH4HTR≥75%.
This allows for the selection of an acid suppressive regimen that allows for symptomatic control
Potassium ion competitive acid blocker is a new type of acid suppressant drug, the main representative of the drug is fumarate funolasine tablets, it and PPI is different, vonorasin tablets in the first use can achieve the greatest acid suppressant effect, but also can quickly alleviate symptoms. About the Vonora film I also had a separate introduction before, you can find the previous article to learn more about it, here will not be too much detail.