【病例学习第12期】Nonerosive Reflux Disease（非糜烂性反流病）

From Pharmacy Times(www.pharmacytimes.com)
Thanks to the author Craig I. Coleman, PharmD(Dr. Coleman is an assistant professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.)

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Nonerosive Reflux Disease

PI comes to the pharmacy with a prescription for lansoprazole (Prevacid) 30 mg once daily. PI tells the pharmacist that about 5 months ago, he started taking lansoprazole for mild heartburn (without esophagitis) with good response. PI notes that after 3 months, his physician let him stop “because he did not like taking pills every day.” Last week his heartburn symptoms returned, however, and his physician gave him this new prescription for lansoprazole. PI asks, “How long will I have to take these pills this time?”

How should the pharmacist respond?


ANSWER

An attempt to stop antisecretory medications, such as proton pump inhibitors and histamine-2 antagonists, is reasonable in patients being treated for heartburn and who have a good response to initial therapy. If symptoms recur in a patient within 3 months, however, the heartburn is often best treated with continuous or maintenance therapy. If symptoms reappear more than 3 months after stopping therapy, repeated courses of acute treatment (roughly 8 weeks in duration) may be effective. Therefore, the pharmacist should inform PI that it is likely that he will continue to be prescribed lansoprazole even if his symptoms disappear in order to prevent symptom recurrence and the development of esophagitis.

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非侵蚀性的反流疾病
PI拿处方到药房里取药，兰索拉唑（兰索拉唑缓释胶囊剂）30mg，每日一次。他告诉药师大约5月前，由于轻微的烧心开始口服兰索拉唑，效果不错。过了3个月，他的医生让他停药，因为他不喜欢每天吃药丸。上周，他的烧心症状复发，医生给他开了兰索拉唑处方。PI问：“这次我要吃多长时间？”
药师如何回答


回答
对于治疗烧心，当最初的治疗效果好的时候，可以适当停用抗分泌的药物，例如：质子泵抑制药，H2受体阻断药。如果3个月内症状复发，最好应该进行持续的治疗。如果停药3个月以后复发，需要重新积极治疗，大约8周一疗程，可以有效。因此，药师告诉PI，像他这样的情况即使症状消失了，但为了防止症状复发或防止发展为食道炎，应继续应用兰索拉唑。

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PI拿着一张每日一次，每次30mg兰索拉唑的处方来到药房。他告诉药剂师，大约5个月前，他开始服用兰索拉唑治疗轻度胃灼热（无食管炎），效果不错。3个月后，他的主治医生让他停药，因为他不喜欢每天服药。上周他的胃灼热症状复发，然而主治医生给了他这个兰索拉唑的新处方。PI问：“这次我得吃这些药丸多长时间？”
药剂师应如何应对？
回答
试图停用抑酸药物，如质子泵抑制剂和组胺-H2受体拮抗剂，对正在接受胃灼热治疗并且初期效果不错的患者是合理的。然而，如果病人在3个月内症状复发，通常最好用连续治疗或维持治疗。如果症状在停药后3个月以上再次出现，需重复治疗过程（约8周的时间）也可能是有效的。因此，药师应告知PI，为了防止症状复发和食管炎的发展，有可能他将持续服用兰索拉唑，即使他的症状已经消失。

学习了，