Admission rates for peptic ulcer in the Trent Region, UK, 1972–2000: Changing pattern, a changing disease?

BACKGROUND AND AIM: Peptic ulcer disease is believed to be less common and less severe as a result of modern medical treatment. We therefore examined changes in the admission rates for patients with duodenal ulcer and gastric ulcer, both emergency (for haemorrhage, perforation or severe pain) and for elective surgery, before and since the introduction of the new advances in therapy. These admission indices reflect disease prevalence and severity. PATIENTS AND METHODS: We identified admission rates during 1972--2000 within the Trent Regional Health Authority, UK (population 4.7 million), from computerised patient information using diagnostic search codes ICD8-10 and expressed as rates per million resident population. Drug expenditure details were obtained from the Department of Health. RESULTS: Emergency admission rates as a whole changed little, a decline in the young being offset by an increase in the elderly. Haemorrhage was the most common reason (approximately 115 per million for duodenal ulcer and 87 for gastric ulcer) throughout [compared with perforation (80 and 21) and pain (90 and 68)]. In contrast, elective surgery has almost disappeared; this reduction began before the introduction of modern treatment. CONCLUSION: Emergency admission rates for duodenal and gastric ulcer for complications or severe pain have fluctuated over the last three decades but with little overall change. In contrast, elective surgery has declined dramatically, as a result of advances in treatment but also from changes in the natural history.     

十二指肠溃疡患者胃上皮化生与幽门螺杆菌关系的研究

目的 研究十二指肠溃疡患者胃上皮化生和幽门螺杆菌的关系。方法 收集门诊行上消化道胃镜检查确诊的十二指肠溃疡患者70例，另选胃和十二指肠黏膜正常患者55例为对照组。用快速尿素酶法和幽门活组织检查半定量法检测幽门螺杆菌(Hp)，苏木素一伊红染色和Schiff过碘酸染色半定量法检测十二指肠球部胃上皮化生。结果 十二指肠溃疡患者与对照组相比，十二指肠球部胃上皮化生检出率高；十二指肠球部胃上皮化生检出率和评分与胃幽门部Hp的检出率和评分无相关关系。结论 Hp不是十二指肠黏膜胃上皮化生的决定因素，也不是十二指肠黏膜胃上皮化生范围得以扩展的因素。十二指肠溃疡病本身的一些特点是十二指肠黏膜胃上皮化生的主要因素。     

奥美拉唑联合呋喃唑酮及阿莫西林治疗十二指肠溃疡疗效观察

目的 观察奥美拉唑联合呋喃唑酮及阿莫西林治疗十二指肠溃疡的疗效.方法 将十二指肠溃疡患者50例随机分为两组:治疗组26例,予以奥美拉唑每日清晨空腹口服20 mg,治疗4周,呋喃唑酮100 mg,3次/d,阿莫西林1000 mg,2次/d,治疗2周,治疗期间不加其他药物.对照组:奥美拉唑每日清晨空腹口服20 mg,治疗4周.结果 治疗组:治愈率53.85%,好转率42.31%,有效率98.16%;对照组:治愈率41.67%,好转率37.50%,有效率79.17%.治疗组和对照组总有效率经统计学处理有显著差异(P＜0.05).结论 奥美拉唑联合呋喃唑酮及阿莫西林治疗十二指肠溃疡能改善临床症状和促进溃疡愈合.     

Studies on the effects of Pluchea indica less root extract on gastroduodenal ulcer models in rats and guineapigs

The methanolic fraction of P. indica root extract was found to possess significant antiulcer activity in different experimental animal models. In preventive antiulcer tests, significant protective actions in acetylsalicylic acid, serotonin and indomethacin-induced gastric lesions were observed in experimental rats. The extract also afforded significant protection to chemically-induced duodenal lesion in guineapigs. Significant enhancement of healing process in acetic acid-induced chronic gastric lesions were also observed in the extract-treated animals.     

健中愈疡片治疗脾虚型胃溃疡的临床与实验研究

目的:用临床观察及动物实验研究健中愈疡片治疗脾气虚型胃溃疡的效果及机理。方法:临床观察从症状、体征、症候疗效方面观察健中愈疡片治疗脾气虚型胃溃疡的效果,动物实验从精神、活动、食欲、皮毛及肠胀气等方面观察健中愈疡片对脾虚证的改善情况。结果:健中愈疡片组治疗后,患者胃脘疼痛、嗳气泛酸、腹胀痞满、纳呆食少、大便稀溏、体倦乏力等症状的改善与治疗前比较具有极显著性差异(P<0.01),效果优于胃舒平片组和法莫替丁胶囊组(P<0.05)。健中愈疡片组治疗后,大鼠精神转好,食欲增加,被毛转光泽,体重增加,肠胀气明显好转,与模型组比较具有极显著的差异(P<0.01)。结论:健中愈疡片正是从改善脾气虚证入手来促进脾气虚型胃溃疡患者的溃疡愈合速度和愈合质量,改善其各种临床症状,从而达到治疗目的。     

消化性溃疡病因分析

[目的]探讨幽门螺旋杆菌感染和非甾体类消炎药应用与消化性溃疡的关系．[方法]对1062例消化不良患者进行内窥镜检壹、快速尿素酶实验和血清抗幽门螺旋杆菌免疫球蛋白检验，同时记录非甾体类消炎药的应用情况，计算消化不良患者消化性溃疡发病事、幽门螺旋杆菌感染率及非甾体类消炎药应用率．[结果]溃疡发病率为29．3％，幽门螺旋杆菌感染串为37．2％，非甾体类消炎药使用率为10．0％．[结论]幽门螺旋杆菌及非甾体类消炎药相互作用干上消化道黏膜．是引发消化性溃疡的重要病因．     

自体腹白线片修补十二指肠溃疡穿孔(附13例报告)

目的探讨用游离自体腹白线片修补急性十二指肠溃疡穿孔的应用价值。方法从2006年1月至2006年7月对13例用自体腹白线片修补急性十二指肠溃疡穿孔的病人的临床资料和随访情况进行回顾性分析,其中2例穿孔大于2cm2,平均手术时间60分钟,平均失血量20ml,平均住院天数9±1天。结果游离自体腹白线片修补急性十二指肠溃疡穿孔13例均痊愈出院。随访15天至6个月,无手术并发症。结论本方法操作较简单、安全、效果好,其适应症广,是一种可行的新方法。     

A CASE OF EARLY GASTRIC CANCER ACCOMPANIED BY DIEULAFOY ULCER IN A YOUNG WOMAN

A case of early gastric carcinoma accompanied by Dieulafoy ulcer is presented. The patient, a 26‐year‐old female, visited our emergency room with chief complaints of massive hematemesis and tarry stool. The initial endoscopic examination revealed a superficial depressed lesion with a faded color accompanied by a tiny ulcer with converging folds at the anterior wall of the middle gastric body. Although no active bleeding vessel was found at that time, the patient was admitted to our hospital for further check‐ups and treatment. On the 6th hospital day, she developed massive hematemesis resulting in shock. Urgent endoscopy, this time, disclosed an exposed bleeding vessel at the small ulcer floor previously mentioned, and endoscopic hemostasis was achieved. Since, however, a biopsy at initial examination from the surrounding depressed area proved carcinoma, a partial distal gastrectomy was subsequently carried out. Histological examination of the resected specimen confirmed the diagnosis of carcinoma limited to the mucosa and submucosa along with findings consistent with Dieulafoy ulcer. This is a rare case of combination of early cancer and Dieulafoy ulcer particularly in such a young patient. A review of the literature is also presented.     

溃疡散预防消化性溃疡复发临床观察

目的 :观察溃疡散对消化性溃疡的抗复发治疗的临床效果。方法 :随机将 80例患者分成溃疡散治疗组 (4 2例 )和雷尼替丁对照组 (38例 )并同时观察两组患者治疗前后溃疡复发情况。结果 :治疗后治疗组溃疡复发率明显低于对照组 ,P <0 .0 1,两组对比有非常显著性差异。结论 :治疗组能明显的改善患者临床症状和降低消化性溃疡复发率。     

岛状皮瓣静脉淤血再通后对大鼠全身情况的影响

目的：探讨岛状皮瓣静脉淤血再通后对全身多脏器的影响。方法：按静脉淤血时间的不同将大鼠分为4组。观察耳部微循环的改变，测量术后肿瘤坏死因子α(TNFα），白细胞介素10（IL－10）的动态变化，观察心，肺，肝，肾，小肠及耳部血管等组织结构及中性粒细胞浸润数目。结果：皮瓣原位缝合组及静脉淤血2h组，耳部微循环、TNFα、IL-10浓度基本保持不变，各脏器结构改变较轻，中性粒细胞浸润数目少。静脉淤血6、10h组，微循环，肺，小肠，血管则有明显组织学改变，大量中性粒细胞浸润其中，但心，肝，肾组织学改变较轻。TNFα浓度再灌注1h达到高峰，其后逐渐下降，IL－10浓度3h达到最低，然后逐渐上升。结论：皮瓣静脉淤血再通后可造成肺、小肠及血管器官损伤，静脉淤血时间越长，再通后则损伤程度越重。全身微循环的改变，中性粒细胞在肺、小肠中的浸润，与血管内皮细胞的粘附及细胞因子TNFα与IL－10的浓度失衡是重要的操作原因。