幽门螺杆菌与功能性消化不良的关系及临床治疗观察

目的 探讨Hp感染与FD的关系及根除HP治疗的疗效.方法 将138例FD患者分成治疗组和对照组,对照组给予促胃动力药物和抗抑郁药物治疗,治疗组在此基础上给予抗Hp药物治疗,观察两组患者治疗后Hp的根除率和临床疗效.结果 治疗结束后的1个月、6个月复查Hp根除率,治疗组患者2次复查后的根除率均为86.96％(60 69),对照组患者2次复查后的根除率均为0;治疗组的治愈+显效为86.95％,对照组为52.17％(P＜0.05);治疗期间两组不良反应程度均较轻,差异无显著性(P＞0.05).结论 Hp与功能性消化不良的关系有密切关系,采用抗Hp药物治疗功能性消化不良,临床效果显著.     

功能性消化不良24h十二指肠运动改变的研究

功能性消化不良(FD)是消化系统常见病,根据症状不同可分为运动障碍样型、溃疡样型、反流样型和非特异型.但是不同类型的运动变化与患者症状相关性缺乏深入研究,FD患者十二指肠24 h运动变化更少见报道.本研究通过检测十二指肠24 h运动变化.探讨FD患者十二指肠运动特点以及与症状分型关系.     

非溃疡性消化不良——现代概念和处理

消化不良是一个常见的症状,估计发病率为8%。非溃疡性消化不良(nonulcerdyspepsiaNUD,功能性消化不良,FD)年龄<25岁年青人流行率高,但>60岁老年消化不良,20%内镜检查正常。NUD含有顽固的上消化道症状持续>3月,既无生化又无结构异常可发现。NUD的病因表现为多因素,不同的机制可引起不同的疾病亚型,根据主要症状分为几个亚型:溃疡样型、反流样型和动力障碍样型。NUD的处理取决于病因和个体对治疗的反应。幽门螺杆菌(Hp)感染在发病机理上的作用和NUD的治疗在一些地区正在研究进行中,且仍有争论。1定义NUD或功能性消化不良(nonulcerdys…     

埃索美拉唑三联疗法治疗幽门螺杆菌阳性十二指肠溃疡临床观察

目的:评价埃索美拉唑治疗幽门螺杆菌(Helicobacter pylori,Hp)阳性十二指肠溃疡近期及远期Hp根除率、溃疡愈合率和症状改善情况.方法:将40例幽门螺杆菌阳性的十二指肠溃疡患者随机分为EAC组(埃索美拉唑+阿莫西林+克拉霉素)和EFA组(埃索美拉唑+阿莫西林+呋喃唑酮),疗程1周,比较治疗后第4周末和1年时Hp根除率和溃疡愈合率,同时比较用药d 1、d 3、d 7、d 28和1年时患者的症状改善情况.结果:EAC组和EFA组间疗效比较差异无统计学意义;所有患者第4周末Hp根除率为92.5%(37/40),1年时Hp根除率为17.5%(7/40);所有患者第4周末溃疡愈合率90%(36/40),在治疗d 7时症状有效率最高,治疗前后症状有效率差异有统计学意义.结论:埃索美拉唑三联疗效治疗Hp阳性十二指肠溃疡近期Hp根除率低,溃疡愈合率和症状有效率高,远期溃疡愈合率和症状改善率也较高.但远期Hp根除率低,这可能与Hp再感染有关.     

幽门螺杆菌感染与胃食管反流的关系

目的探讨胃食管反流病(GRED)与幽门螺杆菌(Hp)的关系。方法确诊的胃食管反流病患者60例及浅表糜烂性胃炎患者63例(对照组),均行幽门螺杆菌检测,再将60例GERD患者分为2组,25例常规三联抗HP治疗,为HP根除组,另外35例作为Hp持续感染组。随访1年。结果 60例GERD患者Hp感染率为58.3%,对照组Hp感染率82.5%,GERD患者Hp感染率低于对照组,差异有统计学意义(P0.05)。Hp根除组GERD复发率高于Hp持续感染组,差异有统计学意义(P0.05)。对照组Hp根除后GERD的发病率为25.5%。结论 Hp感染可能在GERD的发病过程中起保护作用。     

功能性消化不良的分型与情绪障碍关系的探讨

目的探讨功能性消化不良(Functional Dyspepsia FD)分型与心理障碍之间的关系。方法按照FD诊断标准制定详细的症状问卷调查表,由作者之一询问并填写然后归纳分型,同时采用医院焦虑抑郁情绪测定问卷(HAD),有专门训练的主管护师指导,由患者独立填写,并且用统一方式选出100例健康者作对照。结果在136例FD患者中,溃疡样消化不良(FD)24例17.6%,运动障碍样消化不良(DD)48例35.0%,反流样消化不良(RD)25例18.4%,非特异型消化不良(ND)39例28.6%。其中情绪障碍患者59例占43.38%,而100例健康人中11例占11%。FD与健康人两者情绪障碍相比较有明显差异(P<0.01)。结论情绪障碍与FD有一定的关系。     

残胃幽门螺杆菌感染的临床特征及治疗

目的 探讨残胃幽门螺杆菌感染的临床特征及治疗方法.方法 回顾性分析进行残胃胃镜检查的210例及随机抽取同期无胃肠道手术病史进行胃镜检查并做Hp检测的200例患者的临床资料.结果 残胃的Hp感染率为26.2%,不同手术原因Hp感染率比较差异无统计学意义,Billroth-Ⅰ式术后Hp阳性率明显高于毕Billroth-Ⅱ式手术后,有胆汁反流者Hp阳性率低于无胆汁反流,随着胃大部切除术后时间的延长,Hp的感染率愈来愈低,抗Hp的治疗转阴率为87.3%.结论 残胃Hp感染率偏低,但Hp残胃病变加重,目前常用的抗Hp的治疗方案加用胃黏膜保护剂和胃动力药物适合于治疗残胃的Hp感染,有一定的临床应用价值.     

传统三联疗法联合中成药健胃愈疡散治疗138例十二指肠溃疡的临床疗效观察

目的探讨传统三联疗法联合中药健胃愈疡散治疗十二指肠溃疡的临床疗效。方法回顾性分析我院收治的138例十二指肠溃疡患者的临床治疗效果,将138例患者随机分为观察组和对照组,每组行不同治疗方法,观察两组患者临床治疗效果和预后情况。结果观察组经临床治疗后,腹部胀痛、恶心呕吐及食欲不振等症状全部消失,幽门螺旋杆菌(Hp)根除率为94.2%,愈合率95.7%,48周后随访Hp再感染率和溃疡复发率分别为13.8%、12.1%;对照组腹部胀痛、恶心呕吐及食欲不振等症状部分患者消失,Hp根除率为72.5%,愈合率73.9%,48周后随访Hp再感染率和溃疡复发率分别为54.0%、45.1%。结论采用中成药健胃愈疡散联合传统三联疗法治疗十二指肠溃疡的临床疗效显著,能提高Hp根除率加快溃疡面愈合,降低Hp再感染率和溃疡复发率。     

加味柴胡疏肝散联合西药治疗十二指肠球部溃疡患者30例临床观察

目的 探讨加味柴胡疏肝散联合西药治疗十二指肠球部溃疡患者的临床疗效.方法 将符合纳入标准的90例患者按随机数字表法随机分为三组,分别为中西医结合治疗组、西药治疗组、中药治疗组,每组各30例.西药治疗组予口服抗Hp四联疗法2周,后继续服用雷贝拉唑4周.中药治疗组予口服加味柴胡疏肝散,疗程为6周.中西医结合治疗组予口服加味柴胡疏肝散联合抗Hp四联疗法2周,后改为加味柴胡疏肝散联合雷贝拉唑口服4周.治疗结束后1个月复查14 C-呼气试验,并对治疗前、后进行临床症状改善情况及Hp根除率进行比较.结果 ①治疗前后中医症状总积分比较:中西医结合治疗组治疗后临床症状明显改善,优于中药治疗组和西药治疗组(P<0.05).②在治疗Hp疗效方面,中药治疗组根除Hp有效率为56.67%,西药治疗组根除Hp有效率为80.00%,中西医结合治疗组根除Hp有效率为86.67%,中西医结合治疗组和中药治疗组有统计学差异(P<0.05),西药治疗组与中药治疗组有统计学差异(P<0.05),而中西医结合治疗组与西药治疗组无统计学差异(P>0.05).结论 采用加味柴胡疏肝散联合西药治疗气滞型十二指肠球部溃疡伴Hp感染的患者,综合疗效优于单纯中药或单纯西药治疗,无明显毒、副作用,具有较高的临床实用价值.     

根除幽门螺杆菌治疗对功能性消化不良患者临床症状的疗效观察

目的观察根除幽门螺杆菌(Hp)治疗对功能性消化不良(FD)患者临床症状的疗效改善。方法 98例Hp阳性的FD患者随机分为治疗组和对照组,各49例。对照组采取个体化治疗方案,治疗组在此基础上采用三联根除Hp治疗,两组患者治疗14 d后,观察治疗前后临床症状改善情况。结果治疗后两组主要症状积分及总积分均优于治疗前(P<0.05);治疗组餐后饱胀不适、上腹部疼痛及上腹部烧灼感改善程度优于对照组,差异具有统计学意义(P<0.05),两组患者临床早饱感比较差异无统计学意义(P>0.05)。临床主要症状总积分比较,治疗组优于对照组,差异具有统计学意义(P<0.05)。结论对Hp阳性的FD患者采取个体化联合抗Hp治疗,可以明显改善患者临床症状,值得推广应用。     

What is the long‐term outcome of the different subgroups of functional dyspepsia?

BACKGROUND: Functional dyspepsia is often a long-lasting disorder that accounts for substantial healthcare costs. It has been classified into subgroups assuming that it can guide management of dyspepsia. AIM: To evaluate the clinical significance of subgrouping functional dyspepsia in a long-term perspective study. METHODS: Consecutive patients with dyspepsia identified by general practitioners were investigated. Those patients with functional dyspepsia (n=201) were enrolled in this study. Initially, patients were divided into five subgroups (ulcer-like, dysmotility-like, reflux-like, unspecified, and irritable bowel syndrome-like). Patients' medical histories were reviewed after 6-7 years, and the number and outcome of repeated investigations were analysed. At the end of follow-up, patients filled in a questionnaire similar to that at baseline, and were invited for gastroscopy. RESULTS: Only 2% of patients developed peptic ulcer during follow-up, none of them were in the ulcer-like subgroup. When referrals to hospital and examinations during follow-up were registered, no statistically significant differences existed between subgroups. Patients with reflux-like dyspepsia made fewer revisits than others (P=0.02), but had used antidyspepsia drugs during the previous year more often (P=0.036). Stability of the subgroups over time was poor. CONCLUSIONS: Functional dyspepsia is a long-lasting disorder with a very good prognosis. Subgroups of functional dyspepsia play only a minor role in prediction of the long-term outcome, and their usefulness in clinical practice is also hampered by subgroup instability over time.     

The prevalence of clinically significant endoscopic findings in primary care patients with uninvestigated dyspepsia: the Canadian Adult Dyspepsia Empiric Treatment - Prompt Endoscopy (CADET-PE) study

BACKGROUND: Uninvestigated dyspepsia is common in family practice. The prevalence of clinically significant upper gastrointestinal findings (CSFs) in adult uninvestigated dyspepsia patients, and their predictability based on history, is unknown. METHODS: Prompt endoscopy was performed within 10 days of referral, in 1040 adult patients presenting with uninvestigated dyspepsia at 49 Canadian family practitioner centres. Subsequent management strategies during a 6-month follow-up period were determined by the individual family practitioners. RESULTS: CSFs were identified in 58% (603/1040) of patients. Erosive oesophagitis was most common (43%; N = 451); peptic ulcer was uncommon (5.3%; N = 55). Alarm symptoms were uncommon (2.8%; N = 29). Most patients had at least three dyspepsia symptoms, more than 80% had at least six, and approximately half had eight or more. Based on the dominant symptom, 463 (45%) patients had ulcer-like, 393 (38%) had reflux-like and 184 (18%) had dysmotility-like dyspepsia. The patients' dominant symptom was not predictive of endoscopic findings. Oesophagitis was more common in those with dominant reflux-like symptoms and was the most common finding in all subgroups. The prevalence of gastroduodenal findings was similar in all symptom subgroups. Helicobacter pylori (H. pylori) infection (30%; 301/1013) was associated with gastroduodenal findings. CONCLUSIONS: Dyspepsia subclassifications, based on dominant symptom, are of limited value in predicting the presence and nature of CSFs. Oesophagitis was by far the most common diagnosis (43% of patients). CSFs were common in uninvestigated dyspepsia patients and their nature suggests patients could be initially treated effectively, without endoscopy, using empirical acid suppressive therapy.     

不同亚型功能性消化不良胃肌电活动的研究

目的 研究功能性消化不良(FD)的胃肌电活动并探讨其在不同亚型功能性消化不良中的的差异。方法 健康对照组15例,FD64例,按罗马Ⅱ分型标准,溃疡样FD30例,运动障碍样FD34例。应用体表胃电图(EGG)记录胃肌电活动,餐前和标准餐后各30分钟,应用频谱分析法分析并比较正常受试者与FD及其不同亚型的EGG参数。以餐前或餐后正常胃慢波百分比<70％为异常EGG。结果 溃疡样FD和运动障碍样FD异常EGG分别为73.33％和67.64％,显著高于正常组的6.67％(P<0.005)。溃疡样FD和运动障碍样FD功率比<1者分别为46.67％和47.06％,显著大于正常组(0％,P<0.005)。二型FD正常胃慢波明显小于正常组,但胃动过缓显著大于正常组(P<0.05)。除餐前DPIC运动障碍样FD(78.91%)明显大于溃疡样FD外(46.27%,P<0.05),其余各EGG参数二型FD之间比较均无差异(P>0.05)。结论大多数FD病人的EGG异常;EGG可作为FD的筛选检查;溃疡样FD和运动障碍样FD胃电活动无明显差异。     

根除幽门螺杆菌联合莫沙必利治疗功能性消化不良疗效分析

目的评价根除幽门螺杆菌联合莫沙必利治疗幽门螺杆菌阳性的功能性消化不良的疗效。方法将168例幽门螺杆菌阳性的功能性消化不良患者随机分为3组,每组56例。A组给予根除幽门螺杆菌治疗,B组给予莫沙必利治疗,c组给予根除幽门螺杆菌、莫沙必利联合治疗,疗程均为4周。结果c组总有效率为85．71％,显著高于A组和B组（69．64％和71．43％）（P〈0．05）。结论根除幽门螺杆菌联合莫沙必利治疗功能性消化不良,安全有效,值得临床推广。     

Efficacy of omeprazole in functional dyspepsia: double-blind, randomized, placebo-controlled trials (the Bond and Opera studies)

Background:

The efficacy of H₂-receptor antagonists in functional dyspepsia is equivocal and the therapeutic place of proton pump inhibitors in functional dyspepsia is unknown.

Aim:

To evaluate the efficacy of proton pump inhibitor therapy in functional dyspepsia.

Methods:

Patients (n = 1262) with a clinical diagnosis of functional dyspepsia (persistent or recurrent epigastric pain or discomfort for at least 1 month and a normal upper gastrointestinal endoscopy) were randomized to receive omeprazole 20 mg, 10 mg or identical placebo, for 4 weeks. Symptoms were assessed using validated measures. Helicobacter pylori status was determined pre-entry by a ¹³C-urea breath test.

Results:

On an intention-to-treat analysis (n=1248), complete symptom relief was observed in 38% on omeprazole 20 mg, compared with 36% on omeprazole 10 mg and 28% on placebo (P = 0.002 and 0.02, respectively). Among those with ulcer-like and reflux-like dyspepsia, complete symptom relief was achieved in 40% and 54% on omeprazole 20 mg, and 35% and 45% on omeprazole 10 mg, respectively, compared with 27% and 23% on placebo (all P < 0.05, except omeprazole 10 mg in ulcer-like dyspepsia, P = 0.08). There was no significant benefit of omeprazole over placebo in dysmotility-like dyspepsia. Symptom relief was similar in H. pylori-positive and negative cases.

Conclusions:

Omeprazole is modestly superior to placebo in functional dyspepsia at standard (20 mg) and low doses (10 mg) but not in patients with dysmotility-like dyspepsia.

     

Disturbed bowel habits in patients with non-ulcer dyspepsia

BACKGROUND; Emerging medications for non-ulcer-dyspepsia, such as the serotonin-receptor modulators, also affect bowel habits by altering colonic transit. If drugs that alter colonic function were to prove useful in non-ulcer dyspepsia, knowledge of baseline bowel habit disturbances would be potentially critical. AIM: To estimate the rate of non-ulcer dyspepsia patients with clinically relevant constipation or diarrhoea potentially precluding use of motility agents. METHODS: Consecutive patients with non-ulcer dyspepsia (n = 79), gastro-oesophageal reflux disease (n = 135) and organic upper gastrointestinal disease (upper gastrointestinal disease; n = 36) completed a validated symptom questionnaire evaluating predominant bowel habits in the last year. RESULTS: Prevalence of constipation was higher in non-ulcer dyspepsia (34%) than in gastro-oesophageal reflux disease (P = 0.01) and organic upper gastrointestinal disease (P = 0.01), prevalence of alternating diarrhoea/constipation (24%) and diarrhoea (22%) was similar, while prevalence of normal bowel habits was significantly less in non-ulcer dyspepsia (20%; P = 0.01 vs. gastro-oesophageal reflux disease and P < 0.01 vs. organic upper gastrointestinal disease). Constipation was particularly frequent in ulcer-like and dysmotility-like non-ulcer dyspepsia, while prevalence of diarrhoea was lowest in dysmotility-like non-ulcer dyspepsia. A normal bowel habit was equally uncommon in male (21%) and female non-ulcer dyspepsia patients (20%). CONCLUSIONS: Only one of five non-ulcer dyspepsia patients had normal bowel habits based on clinical symptoms; constipation is particularly prevalent. Patients with functional dyspepsia who are prescribed motility altering drugs should be evaluated by taking a thorough bowel habit history.     

舒肝解郁胶囊联合莫沙必利治疗功能性消化不良疗效评价

目的观察抗抑郁中药联合促动力剂治疗功能性消化不良（FD）的疗效及安全性。方法将符合FD罗马Ⅲ诊断标准的86例患者随机分为两组,治疗组46例应用舒肝解郁胶囊2粒Bid、莫沙必利5mgTid。对照组40例单给莫沙必利5mgTid。两组疗程均为6周。采用临床症状评分、HAMD、HAMA评分评定疗效。结果治疗6周后,治疗组临床症状评分、HAMA、HAMD评分均较治疗前明显降低（P〈0.01）,治疗组临床治愈率为63.04%、总显效率为84.78%,均显著高于对照组的20.00%、50.00%,差异有统计学意义（P﹤0.01）。结论舒肝解郁胶囊联合莫沙必利治疗功能性消化不良,疗效肯定,且患者依从性好,不良反应少且轻微。     

短程三联疗法联合心理干预对幽门螺杆菌阳性功能性消化不良的疗效观察

目的：利用功能性消化不良医生报告结局量表对短程三联疗法联合心理干预治疗幽门螺杆菌（Hp）阳性功能性消化不良（FD）的临床疗效进行评估,为治疗该病提供临床依据。方法：选择2016年5月至2017年4月我院门诊就诊的120例Hp阳性FD患者作为研究对象,按照随机数字表法分为对照组与观察组,各60例。对照组给予抗Hp短程三联疗法,观察组则在其基础上加入心理干预。比较两组患者功能性消化不良医生报告结局量表评分（CRO）、临床疗效、Hp根除率、不良反应发生率、Zung式焦虑自评量表（SAS）及Zung式抑郁自评量表（SDS）评分的差异。结果：治疗前,两组患者CRO评分比较,差异无显著性（P>0.05）;治疗后,观察组CRO评分明显小于对照组,差异有显著性（P<0.05）。观察组总有效率为86.67%,对照组为83.33%,两组比较差异无显著性（P>0.05）,但观察组的显效率更高。观察组Hp根除率为61.67%;对照组为58.33%,两组比较差异无显著性（P>0.05）。观察组不良反应发生率为5.0%,对照组为16.67%,两组比较差异有显著性（P<0.05）。治疗前,两组患者的SAS、SDS评分比较差异无显著性（P>0.05）;治疗后,观察组SAS、SDS评分明显小于对照组,差异有显著性（P<0.05）。结论：短程三联疗法联合心理干预应用于Hp阳性FD患者临床疗效确切,有助于提升患者临床症状缓解效率,降低不良反应发生,具有进一步大样本、多指标研究的价值。     

The prevalence of Barrett's oesophagus in a cohort of 1040 Canadian primary care patients with uninvestigated dyspepsia undergoing prompt endoscopy

BACKGROUND: The prevalence of Barrett's oesophagus in patients undergoing gastroscopy may be influenced by possible referral bias. AIM: To present the prevalence of Barrett's oesophagus from the the Canadian Adult Dyspepsia Empirical Therapy Prompt Endoscopy study and to explore potential risk factors for its presence. METHODS: Patients had not been on treatment for dyspepsia for 2-4 weeks prior to endoscopy, which was performed within 10 working days of presentation. RESULTS: Barrett's oesophagus was endoscopically suspected in 53 of 1040 cases (5%) and histologically confirmed by the presence of intestinal metaplasia in 25 (2.4%). The prevalence of biopsy-proven Barrett's oesophagus was 4% in patients with dominant reflux-like symptoms. Sixty-four percent with confirmed Barrett's oesophagus had dominant reflux-like symptoms compared with 37% without Barrett's oesophagus. Barrett's oesophagus was more common in patients >50 years of age; 68% of cases were males. The mean duration of symptoms was 10 years, yet 16% had symptoms of <1-year duration. Endoscopic reflux oesophagitis was present in 68% of confirmed Barrett's oesophagus patients. CONCLUSIONS: Barrett's oesophagus is confirmed on biopsy in about half of endoscopically suspected Barrett's oesophagus patients. Barrett's oesophagus is more common in males, in those with dominant reflux-like symptoms, and in patients with a longer symptom history.     

枳朮宽中胶囊治疗伴有焦虑抑郁状态的功能性消化不良临床研究

目的观察枳朮宽中胶囊治疗伴有焦虑抑郁状态的功能性消化不良(Functional dyspepsia,FD)患者的临床疗效。方法将伴有焦虑抑郁状态的FD患者随机分为观察组(枳朮宽中胶囊组)及对照组(多潘立酮联合路优泰组),分别口服用药,疗程4周。用药前后分别进行FD临床症状评分、Hamilton焦虑量表评分(HAMA评分)及Hamilton抑郁量表评分(HAMD评分),用药期间记录两组患者出现的不良反应。结果两组患者治疗前FD临床症状评分、HAMA评分及HAMD评分差异无统计学意义(P>0.05)。观察组及对照组用药后FD临床症状评分、HAMA评分及HAMD评分较本组用药前均明显下降,差异有统计学意义(P<0.05)。两组间用药前后FD临床症状评分改善率、总有效率、HAMA及HAMD减分率比较差异均无统计学意义(P>0.05)。两组患者用药期间均未出现不良反应。结论枳朮宽中胶囊治疗伴有焦虑抑郁状态FD患者的疗效与多潘立酮联合路优泰相近,值得临床推广。