An etiologic approach to management of duodenal and gastric ulcers.
An etiologic approach to management of duodenal and gastric ulcers.
复制标题
十二指肠和胃溃疡治疗的病因学方法。
作者：
D. Rex
除了极少数例外，消化性溃疡现在可以分为幽门螺杆菌相关的，由非甾体抗炎药（NSAID）引起的，或与Zollinger-Ellison综合征有关。幽门螺杆菌相关性溃疡可通过根除幽门螺杆菌或传统疗法治疗，包括抗分泌药物或硫糖铝。成功根除幽门螺杆菌需要遵守多药治疗方案。因此，候选人应该表现出足够的动机。一般而言，溃疡复发或耐药程度越高，幽门螺杆菌根除的适应症越强。硫糖铝可有效治愈幽门螺杆菌相关的十二指肠溃疡，H2受体拮抗剂可治愈幽门螺杆菌相关的十二指肠溃疡和胃溃疡。奥美拉唑可使幽门螺杆菌相关溃疡愈合更快，尤其适用于治疗大的胃溃疡。NSAID引起的消化不良和NSAID相关的内镜糜烂可通过停用NSAID或减少剂量、随餐给予NSAID和分次给予H2受体拮抗剂进行管理。NSAID诱导的十二指肠溃疡和小的胃溃疡可以用完整的H2受体拮抗剂的分次剂量治愈，即使在NSAID持续使用的情况下。大的（> 5 mm）NSAID诱导的胃溃疡用奥美拉唑治疗最有效，特别是如果患者继续服用NSAID。
With rare exception, peptic ulcers can now be classified as either Helicobacter pylori-related, induced by nonsteroidal anti-inflammatory drugs (NSAIDs), or related to Zollinger-Ellison syndrome. Helicobacter pylori-related ulcers can be treated by eradication of H pylori or by traditional therapies, including antisecretory drugs or sucralfate. Successful eradication of H pylori requires compliance with a multidrug regimen. Therefore, candidates should demonstrate substantial motivation. In general, the greater the degree of ulcer recurrence or resistance, the stronger the indication for H pylori eradication. Sucralfate is effective in healing H pylori-related duodenal ulcers, and H2 receptor antagonists heal H pylori-related duodenal and gastric ulcers. Omeprazole provides faster healing of H pylori-related ulcers, and is particularly useful in treating large gastric ulcers. Dyspepsia induced by NSAIDs and NSAID-related endoscopic erosions are managed by stopping NSAID use or reducing the dosage; administering NSAIDs with meals; and administering H2 receptor antagonists in full split-doses. NSAID-induced duodenal ulcers and small gastric ulcers can be healed with full split-doses of H2 receptor antagonists, even while the NSAID is continued. Large (> 5 mm) NSAID-induced gastric ulcers are most efficiently treated with omeprazole, particularly if the patient continues to take the NSAID.