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Современные подходы к лечению гастроэзофагеальной рефлюксной болезни

https://doi.org/10.22416/1382-4376-2019-29-1-7-16

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Аннотация

Цель: осветить современные подходы к лечению гастроэзофагеальной рефлюксной болезни (ГЭРБ) в соответствии с требованиями медицины, основанной на доказательствах, а также спорные вопросы в ведении пациентов с ГЭРБ.

Основные положения. Снижение массы тела за счет уменьшения калорийности пищевого рациона, правильного распределения его в течение дня, достаточной физической нагрузки должно быть основополагающей рекомендацией немедикаментозного лечения ГЭРБ. ИПП применяют как основной класс лекарственных препаратов при рефлюкс-эзофагите и неэрозивной рефлюксной болезни (НЭРБ), а также при определенных особенностях течения заболевания (например, наличие ночной симптоматики) и при экстраэзофагеальных проявлениях. Эффективность ИПП может зависеть от генетического полиморфизма цитохрома CYP2C19. Для рабепразола характерен преимущественно неферментный путь метаболизма, за счет чего он обладает более стабильным профилем фармакокинетики, в меньшей степени зависящим от полиморфизма CYP2С19. Длительность инициального и поддерживающего курса ИПП определяется формой ГЭРБ. Длительная поддерживающая терапия ИПП показана при эрозивном эзофагите, при наличии пищевода Барретта эта мера рассматривается с позиции канцеропревенции.

Заключение. Ключевым средством медикаментозного лечения ГЭРБ служат ИПП. Выбор ИПП осуществляется на основании факторов, которые определяют эффективность и безопасность препаратов данной группы: скорость наступления кислотосупрессивного эффекта, сила кислотосупрессивного эффекта, время наступления клинической ремиссии при ГЭРБ, зависимость от генетического полиморфизма CYP2C19, отсутствие значимого взаимодействия с другими препаратами, наличие плейотропных эффектов.

Об авторе

Б. Д. Старостин
СПб ГБУЗ «Городская поликлиника № 38»
Россия

заведующий гастроэнтерологическим отделением

191015, г. Санкт-Петербург, Кавалергардская ул., 26



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Для цитирования:


Старостин Б.Д. Современные подходы к лечению гастроэзофагеальной рефлюксной болезни. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2019;29(1):7-16. https://doi.org/10.22416/1382-4376-2019-29-1-7-16

For citation:


Starostin B.D. Contemporary Approaches to the Treatment of Gastroesophageal Reflux Disease. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2019;29(1):7-16. (In Russ.) https://doi.org/10.22416/1382-4376-2019-29-1-7-16

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