第一选择
或
奥美拉唑/碳酸氢钠
:
20/1100 mg~40/1100 mg（胶囊），口服，每日 1 次；20/1680 mg~40/1680 mg（粉剂），口服，每日 1 次
或
埃索美拉唑
:
20-40 mg，口服，每日 1 次
或
或
或
或
停用足量的质子泵抑制剂后经常会出现症状复发。复发率：有高质量的证据表明，对食管炎治愈 6 至 12 个月的患者，质子泵抑制剂可以降低其食管炎或反流症状的复发率，而且比 H2 受体拮抗剂更有效。系统评价或者受试者＞200名的随机对照临床试验（RCT）。
推荐对停用质子泵抑制剂后症状复发的患者以及糜烂性食管炎和 Barrett 食管患者使用质子泵抑制剂维持治疗。[1]Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013 Mar;108(3):308-28.http://gi.org/guideline/diagnosis-and-managemen-of-gastroesophageal-reflux-disease/http://www.ncbi.nlm.nih.gov/pubmed/23419381?tool=bestpractice.com 大部分患者在停用质子泵抑制剂治疗后会复发。
某些非糜烂性反流病患者可以按需或间断给予质子泵抑制剂治疗。[1]Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013 Mar;108(3):308-28.http://gi.org/guideline/diagnosis-and-managemen-of-gastroesophageal-reflux-disease/http://www.ncbi.nlm.nih.gov/pubmed/23419381?tool=bestpractice.com [ 
]What are the benefits and harms associated with de-prescribing long-term proton pump inhibitor therapy in adults?https://cochranelibrary.com/cca/doi/10.1002/cca.1754/full显示答案 一些专家推荐降级治疗试验，[46]Haastrup P, Paulsen MS, Begtrup LM, et al. Strategies for discontinuation of proton pump inhibitors: a systematic review. Fam Pract. 2014 Dec;31(6):625-30.http://fampra.oxfordjournals.org/content/31/6/625.longhttp://www.ncbi.nlm.nih.gov/pubmed/25192903?tool=bestpractice.com[47]Boghossian TA, Rashid FJ, Thompson W, et al. Deprescribing versus continuation of chronic proton pump inhibitor use in adults. Cochrane Database Syst Rev. 2017 Mar 16;(3):CD011969.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD011969.pub2/abstracthttp://www.ncbi.nlm.nih.gov/pubmed/28301676?tool=bestpractice.com但这不是常规治疗方法。
如果改变生活方式有效，可以持续使用。症状管理：我们没有发现有关生活方式评估在反流性食管炎长期管理中发挥作用的随机对照试验。低质量的观察性（队列）研究或者受试者＜200名且方法学存在缺陷的随机对照临床试验（RCT）。
流行病学研究已经发现使用抑酸治疗与骨折以及社区获得性肺炎的患病风险增加有关。[57]Yang YX, Lewis JD, Epstein S, et al. Long-term proton-pump inhibitor therapy and risk of hip fracture. JAMA. 2006 Dec 27;296(24):2947-53.http://www.ncbi.nlm.nih.gov/pubmed/17190895?tool=bestpractice.com[58]Laheij RJ, Sturkenboom MC, Hassing RJ, et al. Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. JAMA. 2004 Oct 27;292(16):1955-60.http://www.ncbi.nlm.nih.gov/pubmed/15507580?tool=bestpractice.com[59]Herzig SJ, Howell MD, Ngo LH, et al. Acid-suppressive medication use and the risk for hospital-acquired pneumonia. JAMA. 2009 May 27;301(20):2120-8.http://www.ncbi.nlm.nih.gov/pubmed/19470989?tool=bestpractice.com 筛查可能的副作用或者因为副作用而避免抑酸治疗没有明确的依据。[3]Kahrilas PJ, Shaheen NJ, Vaezi MF, et al. American Gastroenterological Association medical position statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135:1383-91.http://www.gastrojournal.org/article/S0016-5085%2808%2901606-5/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/18789939?tool=bestpractice.com[60]Chen J, Yuan YC, Leontiadis GI, et al. Recent safety concerns with proton pump inhibitors. J Clin Gastroenterol. 2012 Feb;46(2):93-114.http://www.ncbi.nlm.nih.gov/pubmed/22227731?tool=bestpractice.com 部分[61]Juurlink DN, Gomes T, Ko DT, et al. A population-based study of the drug interaction between proton pump inhibitors and clopidogrel. CMAJ. 2009 Mar 31;180(7):713-8.http://www.cmaj.ca/cgi/content/full/180/7/713http://www.ncbi.nlm.nih.gov/pubmed/19176635?tool=bestpractice.com[62]Ho PM, Maddox TM, Wang L, et al. Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome. JAMA. 2009 Mar 4;301(9):937-44.http://www.ncbi.nlm.nih.gov/pubmed/19258584?tool=bestpractice.com 但非全部[63]O'Donoghue ML, Braunwald E, Antman EM, et al. Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton-pump inhibitor: an analysis of two randomised trials. Lancet. 2009 Sep 19;374(9694):989-97.http://www.ncbi.nlm.nih.gov/pubmed/19726078?tool=bestpractice.com[64]Ray WA, Marray KT, Griffin MR, et al. Outcomes with concurrent use of clopidogrel and proton-pump inhibitors: a cohort study. Ann Intern Med. 2010 Mar 16;152(6):337-45.http://www.ncbi.nlm.nih.gov/pubmed/20231564?tool=bestpractice.com[65]Bhatt DL, Cryor BL, Contant CF, et al. Clopidogrel with or without omeprazole in coronary artery disease. New Engl J Med. 2010 Nov 11;363(20):1909-17.http://www.ncbi.nlm.nih.gov/pubmed/20925534?tool=bestpractice.com 研究发现了当氯吡格雷与质子泵抑制剂合用时，氯吡格雷疗效减弱和可能发生不良后果的证据。[66]Abraham NS, Hlatky MA, Antman EM, et al. ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. Am J Gastroenterol. 2010 Dec;105(12):2533-49.http://www.ncbi.nlm.nih.gov/pubmed/21131924?tool=bestpractice.com 不推荐同时使用氯吡格雷和奥美拉唑。
长期使用 PPI 具有风险；因此，应以尝试停药或将剂量减至控制症状所需的最低剂量为目标进行治疗。[43]Freedberg DE, Kim LS, Yang YX. The risks and benefits of long-term use of proton pump inhibitors: expert review and best practice advice from the American Gastroenterological Association. Gastroenterology. 2017 Mar;152(4):706-15.http://www.ncbi.nlm.nih.gov/pubmed/28257716?tool=bestpractice.com[60]Chen J, Yuan YC, Leontiadis GI, et al. Recent safety concerns with proton pump inhibitors. J Clin Gastroenterol. 2012 Feb;46(2):93-114.http://www.ncbi.nlm.nih.gov/pubmed/22227731?tool=bestpractice.com 使用质子泵抑制剂是 难辨梭菌 相关性腹泻的危险因素之一。[67]US Food and Drug Administration. FDA drug safety communication: Clostridium difficile-associated diarrhea can be associated with stomach acid drugs known as proton pump inhibitors (PPIs). February 2012 [internet publication].http://www.fda.gov/Drugs/DrugSafety/ucm290510.htm
