Role of Helicobacter pylori infection and nonsteroidal anti-inflammatory drug use in bleeding peptic ulcers in Japan
Role of Helicobacter pylori infection and nonsteroidal anti-inflammatory drug use in bleeding peptic ulcers in Japan
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DOI：
10.1007/s00535-005-1720-y
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发表时间：
2006-01-01
影响因子：
6.3
通讯作者：
Fujimoto, K
中科院分区：
文献类型：
--
作者：
Ootani, H;Iwakiri, R;Fujimoto, K
背景幽门螺杆菌感染和非甾体抗炎药（NSAIDs）是众所周知的消化性溃疡的主要原因。本研究旨在描述出血性消化性溃疡在日本的特点。方法。本前瞻性研究评估了2000年1月至2002年12月期间116例消化性溃疡出血性患者。结果。116例患者中有88例（75.9%）存在幽门螺杆菌感染。70例（60.3%）未使用非甾体抗炎药的患者幽门螺杆菌阳性（A组），18例（15.5%）使用过非甾体抗炎药的患者幽门螺杆菌阳性（B组）。在幽门螺杆菌阴性患者中，15例（12.9%）与使用非甾体抗炎药相关（q组）。13例（11.2%）患者无幽门螺杆菌感染或使用非甾体抗炎药史（D组）。在33例有非甾体抗炎药使用史的患者中，11例按需使用非甾体抗炎药，1.4例每日服用低剂量阿司匹林。B组和C组患者年龄明显大于A组和D组，且与A组相比合并疾病的发生率更高。D组有11例患者经内镜检查发现萎缩性改变，提示既往幽门螺杆菌感染，且这些萎缩性改变在出血时仍存在。D组许多患者有严重的合并症。与健康对照组相比，各患者组胃胃窦黏膜中磷脂酰胆碱和磷脂酰乙醇胺浓度均显著降低。结论。28.4%的患者使用非甾体抗炎药导致出血性溃疡；因此，低剂量阿司匹林或按需使用非甾体抗炎药可能导致出血性溃疡。只有2例（1.7%）确诊为幽门螺杆菌阴性、非非甾体抗炎药溃疡。
Background Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs (NSAIDs) are well-known major causes of peptic ulcers. This study aimed to characterize the features of bleeding peptic ulcers in Japan. Methods. This prospective study evaluated 116 patients revealed to have bleeding peptic ulcers from January 2000 to December 2002. Results. Eighty-eight of the 116 patients (75.9%) had H. pylori infection. Seventy (60.3%) patients were positive for H. pylori with no history of NSAID use (group A), and 18 (15.5%) were positive for H. pylori with a history of NSAID use (group B). Among the H. pylori-negative patients, 15 (12.9%) were associated with NSAID use (group Q. Thirteen (11.2%) patients had no H. pylori infection or history of NSAID use (group D). Among the 33 patients with a history of NSAID use, 11 were on-demand NSAID users and 1.4 took daily low-dose aspirin. The patients in groups B and C were significantly older that those in groups A and D, and they more frequently had coexisting diseases compared with group A. In group D, 11 patients had atrophic changes revealed by endoscopic examination, suggesting a past H. pylori infection, and these atrophic changes remained at the time of bleeding. Many of the patients in group D had serious comorbidity. Compared with healthy control subjects, the concentrations of both phosphatidylcholine and phosphatidylethanolamine were significantly decreased in the antral gastric mucosa in all patient groups. Conclusions. NSAID use contributed to bleeding ulcers in 28.4% of patients; thus, low-dose aspirin or on-demand NSAID use may cause bleeding ulcers. There were only two (1.7%) confirmed cases of H. pylori-negative, non-NSAID ulcers.