消化性溃疡病:综述。

Q1 Medicine
Nimish Vakil
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引用次数: 0

摘要

重要性:在美国,消化性溃疡病影响着1%的人口,每年约有54000名患者因消化性溃疡出血而入院治疗:观察结果:在初级医疗机构就诊的上腹部疼痛患者中,约有 10% 的症状是由消化性溃疡引起的。消化性溃疡病的主要病因是幽门螺旋杆菌感染(约 42% 的消化性溃疡病患者会受到幽门螺旋杆菌感染的影响)和阿司匹林或非甾体抗炎药(NSAID)的使用(约 36% 的消化性溃疡病患者会受到阿司匹林或非甾体抗炎药的影响)。消化性溃疡的并发症包括出血(73% 的患者)、穿孔(9% 的患者)和幽门梗阻(3% 的患者)。美国每年有 10,000 人死于消化性溃疡病。内镜检查可明确诊断消化性溃疡病。酸阻滞剂(如奥美拉唑)可在 4 周内治愈约 80% 至 100% 的患者的消化性溃疡,但大于 2 厘米的胃溃疡可能需要 8 周的治疗。根除幽门螺杆菌可将消化性溃疡的复发率从大约 50%至 60%降至 0%至 2%。停用非甾体抗炎药可治愈内镜检查发现的 95% 的溃疡,并将复发率从 40% 降至 9%。如果不希望停用非甾体抗炎药,可更换非甾体抗炎药(例如,从酮咯酸更换为布洛芬),添加质子泵抑制剂(如奥美拉唑或兰索拉唑),并使用铋剂、甲硝唑和四环素等治疗方法根除幽门螺杆菌,同时联合使用奥美拉唑,可降低复发率:消化性溃疡病与住院率和死亡率的增加有关。使用质子泵抑制剂(如奥美拉唑或兰索拉唑)阻酸是主要的治疗方法。如果存在幽门螺杆菌,可通过根除幽门螺杆菌和停用阿司匹林或非甾体抗炎药(如适用)来预防溃疡复发。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Peptic Ulcer Disease: A Review.

Importance: In the US, peptic ulcer disease affects 1% of the population and approximately 54 000 patients are admitted to the hospital annually for bleeding peptic ulcers.

Observations: Approximately 10% of patients presenting with upper abdominal pain in a primary care setting have a peptic ulcer as the cause of their symptoms. The principal causes of peptic ulcer disease are Helicobacter pylori infection, which affects approximately 42% of patients with peptic ulcer disease, and aspirin or nonsteroidal anti-inflammatory drug (NSAID) use, which are etiologic factors in approximately 36% of people with peptic ulcer disease. Complications of peptic ulcer include bleeding (73% of patients), perforation (9% of patients), and pyloric obstruction (3% of patients). Annually, 10 000 people die of peptic ulcer disease in the US. Endoscopy definitively diagnoses peptic ulcer disease. Acid blockers, such as omeprazole, can heal peptic ulcers in approximately 80% to 100% of patients within 4 weeks, but gastric ulcers larger than 2 cm may require 8 weeks of treatment. Eradication of H pylori decreases peptic ulcer recurrence rates from approximately 50% to 60% to 0% to 2%. Discontinuing NSAIDs heals 95% of ulcers identified on endoscopy and reduces recurrence from 40% to 9%. When discontinuing an NSAID is not desirable, changing the NSAID (eg, from ketorolac to ibuprofen), adding a proton pump inhibitor such as omeprazole or lansoprazole, and eradicating H pylori with treatment such as bismuth, metronidazole, and tetracycline combined with omeprazole can reduce recurrence rates.

Conclusions and relevance: Peptic ulcer disease is associated with increased hospitalization rates and mortality. Acid blocking with proton pump inhibitors, such as omeprazole or lansoprazole, is the primary treatment. Recurrence of ulcers can be prevented by eradicating H pylori if present and discontinuing aspirin or NSAIDs if applicable.

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来源期刊
CiteScore
45.40
自引率
0.00%
发文量
0
期刊介绍: JAMA, published continuously since 1883, is an international peer-reviewed general medical journal. JAMA is a member of the JAMA Network, a consortium of peer-reviewed, general medical and specialty publications.
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