Evidence-based clinical practice guidelines for peptic ulcer disease 2020.
Evidence-based clinical practice guidelines for peptic ulcer disease 2020.
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DOI：
10.1007/s00535-021-01769-0
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发表时间：
2021-04
影响因子：
6.3
通讯作者：
Koike K
中科院分区：
文献类型：
--
作者：
Kamada T;Satoh K;Itoh T;Ito M;Iwamoto J;Okimoto T;Kanno T;Sugimoto M;Chiba T;Nomura S;Mieda M;Hiraishi H;Yoshino J;Takagi A;Watanabe S;Koike K
日本胃肠病学会（JSGE）于2020年修订了第三版消化性溃疡循证临床实践指南，并创建了英文版。修订后的指南包括9个项目：流行病学，出血性胃和十二指肠溃疡，幽门螺杆菌（H。pylori）根除治疗、非根除治疗、药物诱导的溃疡、非H.幽门螺杆菌和非甾体抗炎药（NSAID）溃疡，残胃溃疡，手术治疗和保守治疗穿孔和狭窄。治疗消化性溃疡的治疗算法基于溃疡并发症而不同。在NSAID诱导的溃疡患者中，停用NSAID并给予抗溃疡治疗。如果NSAID不能停用，则用质子泵抑制剂（PPI）治疗溃疡。沃诺拉赞（VPZ）联合抗生素被推荐作为H.幽门螺杆菌根除，PPI或VPZ与抗生素被推荐作为二线治疗。未使用NSAID且H. pylori阴性的患者被认为患有特发性消化性溃疡。本指南介绍了预防NSAID和低剂量阿司匹林（LDA）相关溃疡的方法。这些算法因合并使用LDA或NSAID以及溃疡病史或出血性溃疡病史而异。对于有溃疡病史并接受NSAID治疗的患者，建议使用PPI联合或不联合塞来昔布，并建议使用VPZ预防溃疡复发。对于有溃疡病史的患者，建议使用LDA治疗，PPI或VPZ，并建议使用组胺2受体拮抗剂预防溃疡复发。
The Japanese Society of Gastroenterology (JSGE) revised the third edition of evidence-based clinical practice guidelines for peptic ulcer disease in 2020 and created an English version. The revised guidelines consist of nine items: epidemiology, hemorrhagic gastric and duodenal ulcers, Helicobacter pylori (H. pylori) eradication therapy, non-eradication therapy, drug-induced ulcers, non-H. pylori, and nonsteroidal anti-inflammatory drug (NSAID) ulcers, remnant gastric ulcers, surgical treatment, and conservative therapy for perforation and stenosis. Therapeutic algorithms for the treatment of peptic ulcers differ based on ulcer complications. In patients with NSAID-induced ulcers, NSAIDs are discontinued and anti-ulcer therapy is administered. If NSAIDs cannot be discontinued, the ulcer is treated with proton pump inhibitors (PPIs). Vonoprazan (VPZ) with antibiotics is recommended as the first-line treatment for H. pylori eradication, and PPIs or VPZ with antibiotics is recommended as a second-line therapy. Patients who do not use NSAIDs and are H. pylori negative are considered to have idiopathic peptic ulcers. Algorithms for the prevention of NSAID- and low-dose aspirin (LDA)-related ulcers are presented in this guideline. These algorithms differ based on the concomitant use of LDA or NSAIDs and ulcer history or hemorrhagic ulcer history. In patients with a history of ulcers receiving NSAID therapy, PPIs with or without celecoxib are recommended and the administration of VPZ is suggested for the prevention of ulcer recurrence. In patients with a history of ulcers receiving LDA therapy, PPIs or VPZ are recommended and the administration of a histamine 2-receptor antagonist is suggested for the prevention of ulcer recurrence.
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