重磅！2020胃食管反流病专家共识发布，更新要点图表一览

2021-12-23 消化界消化界

本文总结共识更新要点，与大家分享，具体内容还请参照共识全文。

反流病（GERD）是常见的消化系统疾病，其发病率有逐年增高的趋势。近日，2020版《中国胃食管反流病专家共识》（以下简称“共识”）在最新一期《中华消化杂志》上正式发布。时隔6年之后共识再次更新，旨在推动中国GERD的规范诊治，提高学科医生的诊疗能力。本文总结共识更新要点，与大家分享，具体内容还请参照共识全文。

新旧共识对比：更改推荐

注：标红为新版共识主要更新要点

全新抑酸机制P-CAB——获共识首选推荐

P-CAB破局质子泵抑制剂（PPI）治疗无法满足的临床困境

钾离子竞争性酸阻滞剂（Potassium-competitive acid blockers, P-CABs）是一类具有独特抑酸机制的新型抑酸剂，其代表药物为伏诺拉生。伏诺拉生也是第一个在中国上市的P-CAB，获批用于治疗反流性食管炎（RE）。

既往，在RE的治疗中，虽然PPI相较于最早的抑酸药物H2受体拮抗剂（H2RA）具有较好的抑酸效果。但由于其自身机制的特点，使其仍存在一定的局限性3-7：①PPI为前体药物且酸性条件下不稳定，需餐前半小时服用；②半衰期短，无法持久抑酸，需3~5天才能达到稳定抑酸效果，不能解决夜间酸分泌的问题；③只能与活化的H+/K+-ATP酶结合；④RE黏膜愈合率不达标；⑤停药后复发率较高；⑥由于其代谢受到CYP2C19基因多态性的影响，导致治疗药效个体差异大。因此，临床RE的治疗仍有未被满足的需求。

伏诺拉生临床优势显著，证据充分

作为首个进入中国临床的P-CAB，伏诺拉生独特的作用机制很好地克服了PPIs的局限性，使其成为可充分实现RE症状缓解和黏膜愈合治疗目标的优化治疗策略。

多项临床研究显示，伏诺拉生的抑酸作用在第1天即显示全效，抑酸效果持久，疗效明显优于PPI类药物。一项比较伏诺拉生20 mg与艾司奥美拉唑20 mg或雷贝拉唑10 mg在健康成年男性受试者中的抑酸作用研究（V-E-R研究）显示8，伏诺拉生第1天和第7天胃内24 h pH值曲线大部分重合；伏诺拉生强效抑酸，给药第1天和第7天全天胃内pH≥4持续时间所占的比例（%）（pH 4 HTR）高于艾司奥美拉唑和雷贝拉唑；另外，伏诺拉生可以持久抑制夜间酸分泌，给药第1天和第7天夜间胃内pH 4 HTR高于艾司奥美拉唑和雷贝拉唑。

一项日本的Ⅱ期临床研究显示9，随机给予伏诺拉生5 mg、10 mg、20 mg、40 mg qd或兰索拉唑30 mg qd进行8周的治疗，主要终点是4周黏膜愈合率，结果提示伏诺拉生治疗4周各剂量组黏膜愈合率均非劣效于兰索拉唑30 mg，且明显改善RE患者日间和夜间烧心症状，其中对于接受伏诺拉生20 mg治疗的洛杉矶分级（LA）C/D级RE患者4周时的黏膜愈合率为100%，因此，20 mg qd为伏诺拉生治疗RE的推荐剂量。

日本Ⅲ期临床研究表明10，伏诺拉生4周黏膜愈合率（96.6%）与兰索拉唑8周愈合率（95.5%）相当，同时在LA C/D级和CYP2C19快代谢RE患者中，伏诺拉生治疗4周、8周黏膜愈合率均显著高于兰索拉唑，且安全性良好，不良反应发生情况与兰索拉唑相似。

一项发表在GUT杂志上的亚洲多中心Ⅲ期临床研究，也进一步提示伏诺拉生20 mg在4周、8周的黏膜愈合率均不劣于兰索拉唑30 mg，安全性与兰索拉唑相似，提示伏诺拉生可助力RE患者完成高效达标治疗11。

与PPI相比，伏诺拉生兼顾便利与安全

与PPI不同，伏诺拉生作为新型抑酸药物，本身为活性药物，不需要酸激活，不受餐食影响，同时半衰期长12，1日1次给药即可维持良好的抑酸效果，良好的便利性和持久的疗效使得患者服药依从性大大提高。另外，伏诺拉生的安全性与PPI相似，在患者中应用耐受性良好。

伏诺拉生是否为“经济适用”型？我们来说说可能性

在选择药物治疗时，其费用是患者重点考虑的问题。在这一方面，伏诺拉生依然具有较大的竞争力。来自日本的一项RE初始治疗的药物经济学研究显示13，与兰索拉唑相比，伏诺拉生平均一年可减少1.5次就诊，减少49天用药时间，节约2901日元的用药费用，对于RE是更具性价比的优选方案。

另一项来自国际药物经济学和结果研究协会（ISPOR）的研究14，主要采用模型法外推了伏诺拉生的长期疗效和成本8。结果显示，与PPI组相比，伏诺拉生虽然日均费用高，但是由于可以更快地实现黏膜愈合，减少患者的就诊次数，长期来看治疗RE还节约了622元，增加了0.021个质量调整生命年（QALYs）这一健康产出指标。由此，与PPI相比，P-CAB伏诺拉生可为RE患者从临床、经济等多个维度带来获益。

伏诺拉生作为不同于PPIs的新型抑酸药物，治疗RE 4周即可达到黏膜愈合，首剂治疗症状即可缓解。另外，伏诺拉生的安全性及耐受性与PPI无明显差异，且其还具有显著的药物经济学优势。此次P-CAB获得新版GERD中国专家共识的首选推荐，体现出临床专家对P-CAB这类药物抑酸作用的肯定，希望未来其可以更好地被应用于中国临床，惠及更多患者。

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2022-02-24 xuyong523

#反流病#

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2022-06-22 循证小兵

#胃食管#

47 0
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encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Sat Dec 25 07:39:15 CST 2021, time=2021-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1571713, encodeId=4fd115e171338, content=<a href='/topic/show?id=41e33e76137' target=_blank style='color:#2F92EE;'>#反流#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37761, encryptionId=41e33e76137, topicName=反流)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=220d15750403, createdName=feifers, createdTime=Sat Dec 25 07:39:15 CST 2021, time=2021-12-25, status=1, ipAttribution=)]
2022-03-24 ms9000001785445940

学习了

46 0
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encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Sat Dec 25 07:39:15 CST 2021, time=2021-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1571713, encodeId=4fd115e171338, content=<a href='/topic/show?id=41e33e76137' target=_blank style='color:#2F92EE;'>#反流#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37761, encryptionId=41e33e76137, topicName=反流)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=220d15750403, createdName=feifers, createdTime=Sat Dec 25 07:39:15 CST 2021, time=2021-12-25, status=1, ipAttribution=)]
2022-03-20 医者仁者

#胃食管反流病#

52 0
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target=_blank style='color:#2F92EE;'>#专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20648, encryptionId=5d2f206482e, topicName=专家共识)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Fri Jan 07 18:39:15 CST 2022, time=2022-01-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1260726, encodeId=b9471260e26dd, content=<a href='/topic/show?id=2f71834056f' target=_blank style='color:#2F92EE;'>#胃食管反流#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83405, encryptionId=2f71834056f, topicName=胃食管反流)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Sat Dec 25 07:39:15 CST 2021, time=2021-12-25, status=1, ipAttribution=), 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encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Sat Dec 25 07:39:15 CST 2021, time=2021-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1571713, encodeId=4fd115e171338, content=<a href='/topic/show?id=41e33e76137' target=_blank style='color:#2F92EE;'>#反流#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37761, encryptionId=41e33e76137, topicName=反流)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=220d15750403, createdName=feifers, createdTime=Sat Dec 25 07:39:15 CST 2021, time=2021-12-25, status=1, ipAttribution=)]
2022-02-06 TMFEI

学习了，非常有用

33 0
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2022-01-07 snowpeakxu

#专家共识#

27 0
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2021-12-25 jklm09

#胃食管反流#

40 0
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encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Sat Dec 25 07:39:15 CST 2021, time=2021-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1571713, encodeId=4fd115e171338, content=<a href='/topic/show?id=41e33e76137' target=_blank style='color:#2F92EE;'>#反流#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37761, encryptionId=41e33e76137, topicName=反流)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=220d15750403, createdName=feifers, createdTime=Sat Dec 25 07:39:15 CST 2021, time=2021-12-25, status=1, ipAttribution=)]
2021-12-25 zhouqu_8

#食管#

34 0
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encryptionId=f7bc8340ef2, topicName=胃食管反流病)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=医者仁者, createdTime=Sun Mar 20 10:29:33 CST 2022, time=2022-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1190430, encodeId=85a911904303a, content=学习了，非常有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib1QYicmxfdcLzYkz0BOxLjia5Xge3iaCWeLc4uSTcAaWwU3xiaj83Yia5YljZRicayUEXO3F78lYTKtgiblp4pII8a4x9w/0, createdBy=81551949579, createdName=TMFEI, createdTime=Sun Feb 06 06:22:42 CST 2022, time=2022-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1845891, encodeId=d1971845891ec, content=<a href='/topic/show?id=5d2f206482e' target=_blank style='color:#2F92EE;'>#专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20648, encryptionId=5d2f206482e, topicName=专家共识)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Fri Jan 07 18:39:15 CST 2022, time=2022-01-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1260726, encodeId=b9471260e26dd, content=<a href='/topic/show?id=2f71834056f' target=_blank style='color:#2F92EE;'>#胃食管反流#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83405, encryptionId=2f71834056f, topicName=胃食管反流)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Sat Dec 25 07:39:15 CST 2021, time=2021-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1437688, encodeId=4021143e6889c, content=<a href='/topic/show?id=0e311010591a' target=_blank style='color:#2F92EE;'>#食管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101059, encryptionId=0e311010591a, topicName=食管)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sat Dec 25 07:39:15 CST 2021, time=2021-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549754, encodeId=e5311549e5435, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96000, encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Sat Dec 25 07:39:15 CST 2021, time=2021-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1571713, encodeId=4fd115e171338, content=<a href='/topic/show?id=41e33e76137' target=_blank style='color:#2F92EE;'>#反流#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37761, encryptionId=41e33e76137, topicName=反流)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=220d15750403, createdName=feifers, createdTime=Sat Dec 25 07:39:15 CST 2021, time=2021-12-25, status=1, ipAttribution=)]
2021-12-25 xxxx1054

#重磅#

34 0
[GetPortalCommentsPageByObjectIdResponse(id=2046146, encodeId=7b412046146fe, content=<a href='/topic/show?id=010b3e767b2' target=_blank style='color:#2F92EE;'>#反流病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37767, encryptionId=010b3e767b2, topicName=反流病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8dba135, createdName=xuyong523, createdTime=Thu Feb 24 19:39:15 CST 2022, time=2022-02-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1948626, encodeId=15991948626d7, content=<a href='/topic/show?id=87828339e7a' target=_blank style='color:#2F92EE;'>#胃食管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83397, encryptionId=87828339e7a, topicName=胃食管)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=循证小兵, createdTime=Wed Jun 22 20:39:15 CST 2022, time=2022-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1205583, encodeId=5fde1205583d3, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6eb06554538, createdName=ms9000001785445940, createdTime=Thu Mar 24 15:10:38 CST 2022, time=2022-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1204294, encodeId=b5d21204294a9, content=<a href='/topic/show?id=f7bc8340ef2' target=_blank style='color:#2F92EE;'>#胃食管反流病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83407, encryptionId=f7bc8340ef2, topicName=胃食管反流病)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=医者仁者, createdTime=Sun Mar 20 10:29:33 CST 2022, time=2022-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1190430, encodeId=85a911904303a, content=学习了，非常有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib1QYicmxfdcLzYkz0BOxLjia5Xge3iaCWeLc4uSTcAaWwU3xiaj83Yia5YljZRicayUEXO3F78lYTKtgiblp4pII8a4x9w/0, createdBy=81551949579, createdName=TMFEI, createdTime=Sun Feb 06 06:22:42 CST 2022, time=2022-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1845891, encodeId=d1971845891ec, content=<a href='/topic/show?id=5d2f206482e' target=_blank style='color:#2F92EE;'>#专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20648, encryptionId=5d2f206482e, topicName=专家共识)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Fri Jan 07 18:39:15 CST 2022, time=2022-01-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1260726, encodeId=b9471260e26dd, content=<a href='/topic/show?id=2f71834056f' target=_blank style='color:#2F92EE;'>#胃食管反流#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83405, encryptionId=2f71834056f, topicName=胃食管反流)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Sat Dec 25 07:39:15 CST 2021, time=2021-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1437688, encodeId=4021143e6889c, content=<a href='/topic/show?id=0e311010591a' target=_blank style='color:#2F92EE;'>#食管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101059, encryptionId=0e311010591a, topicName=食管)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sat Dec 25 07:39:15 CST 2021, time=2021-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549754, encodeId=e5311549e5435, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96000, encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Sat Dec 25 07:39:15 CST 2021, time=2021-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1571713, encodeId=4fd115e171338, content=<a href='/topic/show?id=41e33e76137' target=_blank style='color:#2F92EE;'>#反流#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37761, encryptionId=41e33e76137, topicName=反流)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=220d15750403, createdName=feifers, createdTime=Sat Dec 25 07:39:15 CST 2021, time=2021-12-25, status=1, ipAttribution=)]
2021-12-25 feifers

#反流#

47 0

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