2002年度《消化病诊断和治疗》节目单一

◎消化性溃疡的诊断和治疗消化性溃疡的发病机制消化性溃疡与幽门螺杆菌消化性溃疡的诊断与鉴别治疗消化性溃疡的并发症与治疗消化性溃疡的现代药物治疗消化性溃疡的手术治疗     

上海市宝山地区消化性溃疡流行病学特点分析

消化性溃疡是一种常见病，各地区该病的流行病学存在差异，目前本地区尚无消化性溃疡流行病学的大宗调查报告。现将我院1994/2001年期间，经胃镜检查的消化性溃疡检出率，消化性溃疡与年龄、性别、季节、职业、Hp感染及烟酒嗜好的关系等进行流行病学分析，基本上代表本地区消化性溃疡的某些临床消化性溃疡特点。     

老年消化性溃疡233例临床分析

消化性溃疡是消化系统的常见病、多发病，好发于青壮年，近年来老年人发病率有所上升。我们2001年行电子胃镜检查4086例，检出消化性溃疡838例，占内镜检查人数的20．51％，其中老年消化性溃疡233例，占消化性溃疡的27，80％。为总结老年消化性溃疡的临床特点，更好地指导治疗，防止并发症，现对这233例老年消化性溃疡作一回顾性分析。     

消化性溃疡的幽门螺杆菌根除

确立幽门螺杆菌感染是消化性溃疡的主要致病因素,这为消化性溃疡的治疗带来革命性的改变。根除幽门螺杆菌使绝大多数消化性溃疡得以根治,提高了病人的生活质量,显著降低消化性溃疡并发症的发生率。对幽门螺杆菌阴性的消化性溃疡,抗酸疗示仍是主要的治疗方法。     

消化性溃疡辨治规律浅探

消化性溃疡辨治规律浅探陈通文，郭遂成关键词溃疡病，中药治法，辨证消化性溃疡是临床常见、多发病，不但发病率高，而且复发率也高，部分病例反复缠绵，经久难愈。中医药治疗消化性溃疡有显著优势。本文就消化性溃疡辨治组方规律略加探讨，仅供参考。１溃疡病活动期本期...     

老年消化性溃疡的特点及治疗的现代理念

本文简介了老年消化性溃疡的概念,分析了老年消化性溃疡的特点,评述了老年消化性溃疡治疗的重点、方法和注意事项,对本课题的研究和临床诊治具有指导意义.     

78例老年人消化性溃疡的临床特征

随着人口老龄化进程的加剧,老年人消化性溃疡的检出率逐年提高,老年人与非老年人消化性溃疡在溃疡发生部位、临床症状、并发症等方面都存在不同表现.为探讨老年人消化性溃疡的临床特征,现对78例老年人消化性溃疡与同期收治的97例非老年人溃疡进行分析比较,现报告如下.     

黄芪建中汤加减治疗消化性溃疡脾胃虚寒证的临床疗效分析

目的 探讨黄芪建中汤加减治疗消化性溃疡脾胃虚寒证的临床疗效.方法 将我院2016年8月-2018年4月的70例黄芪建中汤加减治疗消化性溃疡脾胃虚寒证患者,随机分组,对照组给予奥美拉唑胶囊治疗,黄芪建中汤加减辅助治疗组开展奥美拉唑胶囊联合黄芪建中汤加减治疗.比较两组消化性溃疡脾胃虚寒证治疗总有效率;消化性溃疡脾胃虚寒证痊愈时间、胃脘痛消失时间、反酸消失时间、嗳气消失时间;治疗前后症状积分;不良反应率.结果 黄芪建中汤加减辅助治疗组消化性溃疡脾胃虚寒证治疗总有效率、症状积分、消化性溃疡脾胃虚寒证痊愈时间、胃脘痛消失时间、反酸消失时间、嗳气消失时间对比对照组有优势(P<0.05).两组不良反应均不严重.结论 黄芪建中汤加减治疗消化性溃疡脾胃虚寒证可获得良好价值.     

1519例消化性溃疡的发病情况分析

１５１９例消化性溃疡的发病情况分析阳凡我院自１９８０年５月～１９９６年８月共做胃镜检查１２４５１例，本文着重对消化性溃疡（ＰＵ）的检出率、性别、年龄、发病季节和溃疡部位分布进行分析讨论。１．消化性溃疡的检出率与发病季节，见表１。２．消化性溃疡的年龄分...     

上腹触痛可否作为消化性溃疡的体征?

本文旨在解释上腹触痛是否提示活动性消化性溃疡,以及不同检查者查出的触痛有无重复性。因此,对88例主诉上腹痛,提示消化性溃疡的病人进行研究。所有病人均经胃镜检查证实有无消化性溃疡。凡是以后查出有胰腺炎、肝胆疾病、非食管、胃、十二指肠的腹腔内异常、曾经手术的消化性溃疡等足以解释上腹痛的疾     

Silent peptic ulcer disease: frequency, factors leading to "silence," and implications regarding the pathogenesis of visceral symptoms

BACKGROUND: Peptic ulcer disease may occur in the absence of dyspeptic symptoms. The pathogenesis of dyspepsia in peptic ulcer disease is unclear. Whether the presence of Helicobacter pylori infection or use of non-steroidal anti-inflammatory drugs affects dyspeptic symptoms in patients with peptic ulcer disease has not been determined. The aim of the study was to determine the frequency and risk factors for peptic ulcer disease in a cohort of asymptomatic, unselected patients undergoing routine screening EGD. METHODS: This was a prospective study of a cohort of Chinese subjects undergoing screening EGD as part of a routine health maintenance program. Routine EGD screening was performed in 6457 consecutive subjects who underwent a self-paid, health evaluation. Those with endoscopy-confirmed peptic ulcer disease were enrolled to assess the risk factors that distinguish asymptomatic patients with peptic ulcer disease from patients with symptoms because of peptic ulcer disease. RESULTS: A total of 704 (10.9%) patients were found to have peptic ulcer disease, of which two thirds (n=496) were asymptomatic. Both uni- and multivariate analysis showed that the asymptomatic patients tended to have a larger body mass index, to be habitual tea drinkers, and to have an ulcer that was less than 1 cm in diameter and in a healing stage. Gender, blood group, history of hypertension and/or diabetes, ulcer location, Helicobacter pylori status, use of non-steroidal anti-inflammatories or sedative medications, habitual coffee drinking, and habits with respect to smoking of tobacco or ingestion of alcohol, had no association with symptoms. CONCLUSIONS: The results of this study suggest that silent peptic ulcer disease is common in Taiwan. Dyspeptic symptoms because of peptic ulcer disease may be influenced by intrinsic (body mass index and ulcer characters) and extrinsic (habitual tea drinking) factors. Non-steroidal anti-inflammatory drug use and Helicobacter pylori status had no significant effect on the symptomatology of peptic ulcer disease. These findings may contribute to the understanding of the pathogenesis in the visceral symptoms of peptic ulcer disease.     

Management of peptic ulcer disease not related to Helicobacter pylori or NSAIDs

Helicobacter pylori (H. pylori) infection is widely accepted as the most important factor in the pathogenesis of duodenal ulcer. However, in parallel with more effective eradication of H. pylori, the prevalence of H. pylori is changing, and H. pylori-negative peptic ulcer disease appears to be increasing. When making a diagnosis of H. pylori-negative peptic ulcer disease, it is essential to avoid misclassification because of inaccurate diagnosis. In addition, secondary causes may need to be excluded with appropriate investigations. In the absence of H. pylori, nonsteroidal anti-inflammatory drug usage is the most common cause of peptic ulcer; surreptitious nonsteroidal anti-inflammatory drug usage is a cause of unexplained ulcer disease in up to 60% of patients. Hypersecretory syndromes such as Zollinger-Ellison syndrome, although rare, need to be excluded. Once all known etiological factors are excluded, there remains a group of patients with so-called "idiopathic ulcers." The interplay of etiological factors in the pathogenesis of idiopathic peptic ulcer disease is poorly defined but may include a genetic predisposition, altered acid secretion, rapid gastric emptying, defective mucosal defense mechanisms, psychological stress, and smoking. The management of idiopathic peptic ulcers is not defined; they appear to be more resistant to standard therapy, can be associated with more frequent complications, and those that relapse may require long-term maintenance therapy.     

Particular features of the clinical manifestation, course and treatment effects of stomach and duodenal ulcers depending on the functional activity of ribosomal genes]

The article presents a study of the functional activity of ribosomal genes in 134 patients with gastric and duodenal ulcer and 48 healthy subjects. A statistically significant reduction of this parameter for patients with peptic ulcer vs. the general population was shown. The authors demonstrated the relation between specific features of the peptic ulcer clinical picture, its progress, results of treatment of these disease entities and functional activity of ribosomal genes. The relation between the functional activity of ribosomal genes, ulcer localization and progress of ulcer complications was demonstrated. The results achieved suggest that the protein synthesis system is involved in all stages of peptic ulcer pathogenesis and sanogenesis.     

Helicobacter pylori is a risk factor for peptic ulcer disease in cirrhotic patients. A meta-analysis

BACKGROUND : Peptic ulcer disease is highly prevalent in cirrhosis, and ulcer complications are a major cause of morbidity in these patients. Helicobacter pylori infection is considered the chief aetiological factor of ulcer disease. However, in cirrhotic patients the role of H. pylori in the pathogenesis of peptic ulcer remains uncertain. AIM : To evaluate the evidence of the pathogenic role of H. pylori infection in peptic ulcer disease in patients with cirrhosis. MATERIALS AND METHODS : An extensive MEDLINE search of the literature was performed. Studies reporting the prevalence of H. pylori infection in cirrhotic patients with and without ulcers were selected. Meta-analysis was conducted using RevMan 4.0.3. Pooled odds ratios were calculated for each comparison, using a fixed model analysis. RESULTS : The search identified seven studies with a total of 976 patients with cirrhosis (275 cases with ulcer disease and 701 controls). The prevalence of H. pylori infection in patients with peptic ulcer disease was higher than in those without. The pooled odds ratio was 2.70 (95% CI, 1.91-3.82). H. pylori infection was associated more or less equally with duodenal and gastric ulcers. CONCLUSION: H. pylori infection increases the risk of peptic ulcer disease in patients with cirrhosis.     

Epidemiology of peptic ulcer disease in Wuhan area of China from 1997 to 2002

AIM: To describe the epidemiological features of peptic ulcer disease in Wuhan area during 1997-2002, to analyze the sex, age and occupation characteristics, as well as the geographic distribution of peptic ulcer disease, and to determine the effective methods of preventing and controlling peptic ulcer disease. METHODS: In the early 1980s, the peptic ulcer disease registry system was established to collect the data of peptic ulcer disease in Wuhan area. Here we performed a statistically detailed analysis of 4876 cases of peptic ulcer disease during 1997-2002. RESULTS: The morbidity of peptic ulcer disease between males and females was significantly different (chi(2) = 337.9, P<0.001). The majority of peptic ulcer diseases were found at the age of 20 to 50 years. Because of different occupations, the incidence of peptic ulcer disease was different in different areas. CONCLUSION: The incidence of peptic ulcer disease is highly associated with sex, age, occupation and geographic environmental factors. By analyzing the epidemiological features of peptic ulcer disease, we can provide the scientific data for prevention and control of peptic ulcer disease.     

Determinants of disease outcome following Helicobacter pylori infection in children.

Helicobacter pylori infection is primarily acquired during childhood, causes chronic, active gastritis and peptic ulcer disease, and is associated with the development of gastric malignancies. However, only a small number of infected individuals ever develop the more severe sequelae of peptic ulcer disease and gastric cancers. Therefore, the identification of bacterial and host factors that play a role in determining the outcomes and pathophysiology of infection is a major focus of current research. Recent advances in the understanding of disease pathogenesis are critically considered, with particular reference to the pediatric population.     

Immunoreactive-Somatostatin, Substance P, and Calcitonin Gene-Related Peptide Concentrations of the Human Gastric Mucosa in Patients with Nonulcer Dyspepsia and Peptic Ulcer Disease

Changes in immunoreactive (ir)-somatostatin, substance P, and calcitonin gene-related peptide concentrations of the human gastric mucosa were examined in subjects with nonulcer dyspepsia (NUD) and peptic ulcer to clarify the relationship between these peptides and dyspeptic symptoms. Fifty-six patients with NUD were divided into two subject subgroups as follows: 22 patients with upper abdominal discomfort, nausea, and/or vomiting (motility disorder group) and 34 patients complaining of upper abdominal pain [ulcer-like disorder (UD) group]. These patients were compared with either an age- and sex-matched group of asymptomatic outpatients without any organic disease (control group: n = 51), or to a group with peptic ulcer (PU group: n = 30). Ir-somatostatin concentrations of the gastric mucosa were significantly higher in UD group than in PU, motility disorder, or control group, and ir-substance P concentrations in the UD group were higher than in the PU group. No difference in ir-calcitonin gene-related peptide concentrations was observed among the four groups. These results indicate that there may be two distinct subgroups in NUD, and that NUD is not just a stage within the spectrum of peptic ulcer disease from the viewpoint of several gastrointestinal-hormone concentrations of the human gastric mucosa.     

"Hepatogenic ulcer": theories and facts (author's transl)]

A review of literature is given concerning the incidence, pathogenesis and clinical relevance of peptic ulcer in chronic liver disease. 1. Today there is no doubt about a highly significant incidence of peptic ulcer in chronic liver diseases, especially in cirrhosis of the liver. Therefore it seems reasonable to use the term "hepatogenic ulcer". 2. Assuming a relation between chronic liver disease and peptic ulceration several theories are discussed with regard to the causality and etiology. Most investigators suppose the diseased liver as "primum movens" in peptic ulceration by means of conditioning different ulcerogenic factors. 3. The clinical finding of increased frequency of peptic ulcer in cirrhotics despite of reduced gastric acid output is no contradiction. It can be explained by relative disturbance of the balance between aggressive and protective mechanism, the latter being diminished. Although a dysfunction of gastric mucus is recently assumed, the specific pathogenetic factor is not clear up to now. 4 Nevertheless, there is no doubt about the clinical relevance of this type of ulcer, given by diagnostic and therapeutic problems and pitfalls.     

Self-perceived stress and the risk of peptic ulcer disease. A longitudinal study of US adults.

BACKGROUND--Although many physicians and laypersons believe that stress plays a role in the occurrence of peptic ulcer disease, the importance of stress in the pathogenesis of peptic ulcers remains controversial. METHODS--To investigate the relationship between perceived stress and peptic ulcer disease we used data from the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study--a nationally representative cohort study of US adults. This analysis included 4511 persons who had not previously been diagnosed with peptic ulcer disease. RESULTS--At baseline, 68% of the cohort perceived themselves as stressed. During 13 years of follow-up, 208 persons developed ulcers; the cumulative incidence of ulcers was 7.2% for persons who were stressed and 4.0% for persons who were not. After we adjusted for age, sex, education, smoking status, and regular aspirin use, persons who perceived themselves as stressed were 1.8 times more likely to develop ulcers than those who did not (95% confidence interval, 1.3 to 2.5). We also found a graded relationship between the perceived amount of stress and the incidence of peptic ulcers; relative to nonstressed persons, the relative risk of developing an ulcer was 1.4, 1.9, 2.3, 2.4, and 2.9 at five increasing levels of stress. CONCLUSIONS--These findings suggest that persons who perceive their lives as stressful may be at increased risk for the development of peptic ulcer disease.     

Effect of a Specific Cyclooxygenase-Gene Polymorphism (A-842G/C50T) on the Occurrence of Peptic Ulcer Hemorrhage

Cyclooxygenases (COX) catalyze the conversion of arachidonic acid to prostaglandins (PGs). COX-inhibiting drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs), increase the risk for peptic ulcer disease. As a corollary, COX gene polymorphisms could be important in the pathogenesis of peptic ulcer disease because these affect prostaglandin formation and impair its protective effect at the level of the gastric mucosa. This study was designed to investigate the association between the functional single–nucleotide polymorphism, A-842G/C50T, in the COX-1 gene and peptic ulcer bleeding. We obtained DNA samples from 106 patients who underwent upper gastrointestinal endoscopy because of bleeding peptic ulcer disease and from 88 healthy control subjects. Genetic polymorphism in A-842G/C50T was determined by PCR followed by restriction-fragment-length-polymorphism analysis. Adjusted logistic regression analysis was performed to evaluate the associations. Risk factors associated with peptic ulcer bleeding were male gender (odds ratio, 4.78; 95% confidence interval, 2.6–8.8) and NSAID/aspirin-use (odds ratio, 38.39; 95% confidence interval, 14.2–103.6). The A-842G/C50T heterozygote was less frequent in peptic ulcer bleeding (n = 7) compared with healthy control subjects (n = 11). The adjusted risk for peptic ulcer bleeding among individuals who were heterozygote for the A-842G/C50T polymorphism was 0.75 (range, 0.19–3.01) compared with wild type. The COX-1 A-842G/C50T SNP does not influence the risk for developing peptic ulcer bleeding. Dr. Joost P. H. Drenth is a recipient of a NWO-VIDI grant.