延边地区消化性溃疡4 348例胃镜分析

目的探讨少数民族地区消化性溃疡的发病学特点.方法分析1990年至1998年间延边地区的28547例内镜检查患者.结果在所有被检查患者中检出消化性溃疡4348例(15.23%),其中十二指肠溃疡2097例(48.22%),胃溃疡1921例(44.18%),复合性溃疡330例(7.59%).消化性溃疡中,男2974例(19.05%),女1374例(10.62%).男女检出率差异显著(P＜0.01);朝鲜族占2727例,汉族占1621例,检出率分别为13.96%和17.98%,但检出率差异显著(P＜0.01).结论延边地区消化性溃疡中汉族检出率高于朝鲜族,男性高于女性.     

Perforated peptic ulcer in Hong Kong and New South Wales

Direct comparisons of ulcer perforation rates and trends between countries have not been made in the past. Data on hospital admissions for perforated peptic ulcer during 1 January 1979 to 31 December 1985 were collected in Hong Kong (5868 perforations) and New South Wales, Australia (1669 perforations). Age and sex specific rates per 100,000 population were calculated. In Hong Kong, annual duodenal ulcer and gastric ulcer perforation rates were 13-16 and under two per 100,000 population respectively. In New South Wales, the corresponding rates were between three and four and under two per 100,000 population, respectively. The male:female ratios for duodenal ulcer perforation were consistently about 5:1 in Hong Kong and 2:1 in New South Wales, and for gastric ulcer perforation about 2:1 and 1:1, respectively. The incidence of perforation increased with age, and there was a statistically significant rise, over time, in duodenal but not gastric ulcer perforation rates in persons aged over 60 years in New South Wales; similar trends were seen in Hong Kong. Thus duodenal ulcer perforation occurs five times more commonly in Hong Kong than in New South Wales and this is largely accountable for by the higher rates of duodenal ulcer perforation in Chinese than in Australian males. Such geographical differences can best be explained by the occurrence of multiple aetiological mechanisms in ulcer perforation. Furthermore, there appears to be an increased susceptibility and an appreciable rising trend for duodenal ulcer perforation to occur in the elderly.     

What is a Dieulafoy Ulcer—Relationship between Dieulafoy Ulcer and Ul-II Ulcer

Abstract: A Dieulafoy ulcer is defined as a gastric ulcer with a massive hemorrhage from a shallow circular depression with an eroded artery in the center. The disease entity has been variously described as Dieulafoy ulcer, exulceratio simplex, gastric aneurysm or submucosal vascular malformation. In this study, the relationship between Dieulafoy ulcers and hemorrhagic Ul-II shallow solitary ulceration was investigated according to the macroscopic and histologic findings of the resected stomach. The hemorrhagic Ul-II solitary ulcers resected were located on the upper or middle gastric body. Most of them were small sized (under 10 mm) ovoid ulcers, and had exposed (eroded) arteries on the ulcer floor. Histologically, the Ul-II ulcers showed ulceration in the acute phase without fibrosis. We concluded that a Dieulafoy ulcer and hemorrhagic solitary Ul-II ulcer are the same. In fact, a Dieulafoy ulcer has no special pathogenesis such as congenital abnormal vessels, aneurysm, etc.     

无痛性消化性溃疡的临床特点——附956例对比分析资料

956例消化性溃疡中,无疼痛溃疡134例(Ⅰ组)占 14.0％,为胃溃疡的7.8％,十二指肠溃疡的 18.9％;有规律疼痛554例(Ⅱ组);无规律疼痛268例(Ⅲ组)。三组对比结果,Ⅰ组内女性、35岁以下青年及60岁以上老年患者相对偏多,病程短者较多,十二指肠溃疡及小于1cm溃疡较多。无痛溃疡组87.3％出现合并症,与有痛溃疡相比,无痛溃疡发生穿孔者比例高;而出血和幽门梗阻与有痛溃疡无明显差别。本组资料还表明,溃疡病吸烟发生疼痛者多;饮酒者三组间无显著差异;因其他原因经常服止痛剂者无痛性溃疡增多,本组为35.8％;A及AB型血者无痛性溃疡相对少见,本组分别为7.9％和4.5％。     

A Case of Kissing Esophageal Ulcers of Unknown Etiology

Abstract: A 41-year-old man with esophageal ulcers of unknown etiology is reported. Endoscopic examination was performed for evaluation of swallowing difficulty. The lesions were located in the middle portion of the esophagus. There were no findings correlating with either peptic ulcer or reflux esophagitis. In addition, he had no history of provoking factors, such as bacterial, chemical, traumatic or physical agents. Although the cause of these lesions was not clarified, we diagnosed acute benign ulcers following histological examination of the biopsy specimens. The patient was treated with a proton pump inhibitor and sodium alginate. The dysphagia and other symptoms subsided promptly, and the lesions healed completely within three weeks. We discuss herein the relationship between endoscopic findings and the etiology of kissing ulcer.     

溃疡病的流行病学研究：北京地区358 644例胃镜分析

北京地区２３所医院自１９８４年１９９３年胃镜检查３５８６４４例，共检出消化性溃疡（ＰＵ）５７５２２例，检出率为１６．０４％。其中十二指肠溃疡（ＤＵ）４３５２９例（上中７５．６５％），胃溃疡（ＧＵ）１３２９７例（占２３。１１％），二者之比为３．２７：１。ＰＵ中男４４３４７例（７７．０８％），女１３１８５例（２２．９１％），男女之比为３．３６：１。ＤＵ中，男３３６２７例（７７．２５％），女９９０２例（     

REFRACTORY GASTRIC ANTRAL ULCER OF UNKNOWN ETIOLOGY

We report a Helicobacter pylori‐negative patient with multiple gastric antral ulcers of unknown etiology and without a history of taking non‐steroidal anti‐inflammatory drugs (NSAIDs). The patient was a 68‐year‐old woman, and her serum gastrin and pepsinogen levels were within normal limits. The antral ulcers were refractory to treatment with a proton pump inhibitor (PPI) or an H2 receptor antagonist alone. However, since nocturnal gastric acid breakthrough was observed, both drugs were given in combination, which resulted in the healing of the ulcers.     

Bleeding peptic ulcer occurring in hospitalized patients

We reviewed 84 consecutive cases of peptic ulcer hemorrhage, which occurred, in an area of 270,000 people, from 1986 to 1988, in patients already hospitalized for other diseases (in-bleeders). These subjects were compared with a prospective series of 386 patients who initially bled as out-patients and were then admitted (out-bleeders). Of 84 hemorrhages in hospitalized patients, 41 followed major surgery, while 43 were associated with other severe conditions. Bleeding site was duodenal in two thirds. Mean age was 67 ± 15 years versus 59 ± 15 among out-bleeders. Fifty percent of in-bleeders had recently received nonsteroidal antiinflammatory drugs (NSAIDs), and one third were on anticoagulants and 10% on corticosteroids; in 39 (46%) bleeding was shown to be persistent or recurrent, 5 (5.9%) underwent endoscopic and 18 (21%) surgical therapy; 29 died (34%). The corresponding figures among out-bleeders were: further bleeding 80 (20.7%), endoscopic therapy 12 (3.1%), surgery 25 (6.5%), deaths 17 (4.4%). As regards in-bleeders, only active bleeding and endoscopic stigmata emerged as statistically significant risk factors for further bleeding. The latter was shown to be significantly related to mortality. The most relevant finding was, however, that NSAIDs and anticoagulants, in association with stress and aging, are very frequently involved in peptic ulcer bleeding of hospitalized patients. The fatal outcome of one third, despite all available treatments, highlights the importance of prevention against drug- and stress-related mucosal damage in in-patients suffering from severe diseases.     

Complications associated with ulcer recurrence following gastric surgery for ulcer disease

The present study is an attempt to assess the risks of the complications associated with recurrent ulcers in patients who have undergone gastric surgery and to determine whether these risks differ from those observed in patients receiving long term maintenance treatment with H2-receptor antagonists for ulcer disease. One hundred and thirty studies reported in the literature during the past three decades have been analysed to determine both the approximate rate of ulcer recurrence and the proportion of patients with recurrent ulcers who have presented with either haemorrhage or perforation following the various types of gastric surgery for ulcer disease. From these data, estimates of the risks of haemorrhage and of perforation during the years following gastric surgery have been calculated. Vagotomy and antrectomy is associated with a low risk of ulcer recurrence (< 1%) and the risk of complications in later years is accordingly very small (< 0.5°/o). Partial gastrectomy, although associated with low recurrence rates, has a higher risk of complications (1.3% for haemorrhage, 0.3% for perforation) because the proportion of recurrent ulcers that present with haemorrhage or perforation is high (33% and 8%, respectively). Truncal vagotomy plus drainage (TV+D) and highly selective vagotomy (HSV) are associated with recurrence rates of 9% and 12%, respectively, but ulcer recurrences following these operations are less frequently accompanied by complications then recurrences after gastric resection and, as a result, the risks of haemorrhage (1.7% for TV+D; 1.3% for HSV) are similar to the risks after gastric resection. During long term (five years or more) maintenance treatment with H2-receptor antagonists, the risks of haemorrhage and perforation are < 2% and < 0.5%, respectively. It appears, therefore, that the likelihood of developing haemorhage or perforation following gastric surgery is of the same order as that during maintenance treatment with H2-receptor antagonists, at least during the first decade of follow-up.     

梗阻性黄疸与消化性溃疡

研究234例梗阻性黄疸和209例非黄疸病人的消化性溃疡发病情况.结果黄疸组42例(17.9%),而对照组仅5例(2.4%)发现胃或十二指肠溃疡.十二指肠溃疡发病率两组有显著差别,而胃溃疡则两组发生率无明显差别.黄疸持续的时间对溃疡的发生无明显影响.胆总管阻塞者溃疡发生率高,而胆总管以上部位阻塞者溃疡发生率与对照组无明显差异.本研究进一步证实了胃酸在十二指肠溃疡形成中的重要作用.     

A double-blind, randomized, parallel group study of omeprazole and ranitidine in Korean patients with gastric ulcer

Abstract The efficacy of the proton pump inhibitor omeprazole, 20 mg every morning, was compared with that of the H₂-receptor antagonist ranitidine, 150 mg every morning and at bedtime, in a double-blind randomized parallel group study in 250 patients with gastric or prepyloric uicers. At both 4 and 8 weeks, significantly more patients had healed ulcers in the omeprazole group than the ranitidine group, whether the results were analysed on a per-protocol or an intention-to-treat basis. At 4 weeks, 74% of patients in the omeprazole group were healed compared with 51% in the ranitidine group ( P = 0.001), and at 8 weeks the corresponding values were 99 and 82% ( P = 0.001, per-protocol cohort). Omeprazole treatment and small ulcer size significantly increased the probability of healing, but smoking had no significant effect. Patients in the omeprazole group had significantly fewer occurrences of daytime epigastric pain during the first 4 weeks than the ranitidine group ( P = 0.0037), as shown by their diary cards. Both treatments were well tolerated.     

消化性溃疡发病与气象因素的关系

此文综述了近年来世界范围内有关气象因素对消化性溃疡的发病及其并发症发生的有关研究结果,显示消化性溃疡及其出血、穿孔等并发症的发病均有明显的季节性波动,与某些具体的气象因子如气温、气压等有较密切的关系。气象因素影响溃疡发病的机理尚不清楚,内分泌激素紊乱可能在其中起作用。     

Antibody to herpes simplex virus type 1 in peptic ulcer patients

It has been postulated that herpes simplex virus type 1 may be a causative factor of duodenal ulcer. Serum antibody titres to herpes simplex virus type 1 in duodenal and gastric ulcer patients were compared with race-, sex- and age-matched controls. No differences in antibody titres could be demonstrated between duodenal ulcer and gastric ulcer patients and their respective controls, between gastric ulcer and duodenal ulcer patients or between acute and convalescent sera in either gastric or duodenal ulcer. Although Chinese are more susceptible to ulcer disease than Malays and Indians, antibody titres were comparable between subjects of different races. The results of this study do not support a causal role for herpes simplex virus in peptic ulcer disease.     

Discriminant factors of gastric ulcer healing by colloidal bismuth

One hundred and twelve patients with 49 corpus and 35 prepyloric gastric ulcers and 28 duodenal ulcers associated with gastric ulcers were entered into a stratified, controlled double-blind randomized study comparing the healing efficacy of colloidal bismuth suspension with placebo. Healing of corpus and prepyloric ulcers, but not duodenal-ulcer associated gastric ulcers, was significantly better with the bismuth compound than with placebo. The clinical, personal, ulcer and acid secretory data of these patients were prospectively collected and evaluated by stepwise discriminant analysis in two phases. In the first phase, the collected data of 91 consecutive patients were entered into computer analysis. The derived discriminant function classified patients into healed and unhealed categories with a sensitivity of 82%, specificity of 77%, positive diagnostic value of 73%, negative diagnostic value of 85% and diagnostic efficiency of 79%. In phase two, the discriminant function from phase 1 was applied prospectively to 21 patients to predict the outcome of treatment. Five out of five healed and 11/16 unhealed gastric ulcers were correctly predicted, giving a diagnostic efficiency of 76%. The present study shows that healing or non-healing of gastric ulcer can be predicted with reasonable accuracy by discriminant analysis. In addition, discriminant analysis identified, aside from the efficacious drug, ulcer size, young age, co-existing duodenal ulcer, and concomitant medical condition as adverse factors for gastric ulcer healing.     

Observations on peptic ulcer in Shan Dong, China

The study consisted of 10 994 inpatients with peptic ulcer in Shan Dong province. The ratio of duodenal to gastric ulcer was 1.59 : 1. The ratio of males to females was 6.8 : 1 for duodenal ulcer and 4.6 : 1 for gastric ulcer. The highest incidence was in adolescence and young adults and the presentation occurred more commonly in winter. A study of blood groups revealed that there was no relationship between blood group and duodenal or gastric ulcer. The majority (71.9%) of patients with peptic ulcer had complications of upper gastrointestinal bleeding, perforation or gastric outlet obstruction. Bleeding and obstruction were equally common in gastric and duodenal ulcer, but perforation was more common in gastric ulcer.     

Helicobacter pylori and gastric acid output in peptic ulcer disease

Helicobacter pylori is associated with peptic ulcer, and a causal relationship has been postulated. We investigated the association betweenHelicobacter pylori and gastric acid output. Two hundred forty-one patients were studied: 173 with duodenal ulcer, 51 with gastric ulcer (41 corpus, 10 prepyloric), and 17 with combined gastric and duodenal ulcer. In 194 patients (80%),Helicobacter pylori could be demonstrated histologically from gastric antral biopsies. The presence or absence ofHelicobacter pylori was not influenced by age, sex, or use of tobacco or analgesics. Patients with duodenal ulcer or combined gastric and duodenal ulcer had similar gastric acid outputs irrespective of the presence or absence ofHelicobacter pylori. However, gastric ulcer patients withHelicobacter had higher basal and maximal acid outputs when compared to patients withoutHelicobacter (mean basal output: 4.1 mmol/hr vs 2.4,P<0.05; mean maximal output 19.5 mmol/hr vs 14.4,P<0.05). AlthoughHelicobacter pylori is associated with both gastric ulcer and duodenal ulcer, its significance may be different in the two diseases.     

胃溃疡与十二指肠溃疡胃电图变化的探讨

目的分析胃溃疡与十二指肠溃疡患者胃肌电活动特点,探讨消化性溃疡病患者节律性疼痛、腹胀、反酸等临床症状与胃动力的关系,为消化性溃疡病临床治疗提供客观依据和指导。方法对44例胃溃疡和十二指肠溃疡患者及20例健康志愿者进行胃电图监测,记录主频率,主功比,各频段胃电所占百分比等指标。结果胃溃疡患者多存在胃电失常,以混合节律失常和胃动过缓节律失常为主;而十二指肠溃疡以混合节律及胃动过速失常为主。结论消化性溃疡患者大多有胃动力障碍。胃电图检查结果对其治疗具有一定的指导意义。     

Safety of Ranitidine Maintenance Treatment of Duodenal Ulcer

During maintenance treatment with nocturnal ranitidine (150 mg) for 1 year, 38% of duodenal ulcers relapsed. Twenty-one patients whose ulcers remained healed after maintenance treatment for 1 year continued to receive ranitidine (150 mg at night) for a further year, while 26 patients with healed ulcers received placebo in a randomized double-blind study. The rate of recurrence of duodenal ulcers during the 2nd year of follow-up study was 18% in ranitidine-treated individuals and 87% in those receiving placebo. The ulcer recurrences of patients receiving ranitidine tended to be asymptomatic and were clinically mild in the rest. Recurrences in patients receiving placebo were usually symptomatic and significantly more likely to be associated with bleeding. We conclude that ulcers that remain healed after 1 year's maintenance treatment with ranitidine tend to remain healed if maintenance treatment is continued. Moreover, this type of continuous treatment of duodenal ulcer is clinically safer than no treatment of the ulcer disease.     

Epidemiological Aspects of Peptic Ulcer Disease on the Faroe Islands: An Interim Report

A prospective epidemiological study was carried out from 1981 to 1983 to determine the incidence of peptic ulcer on the Faroe Islands. The annual incidence of first-time-diagnosed peptic ulcer was on the average 3.3 per 1000 inhabitants aged 15 years and older. No significant changes in incidence were observed during the 3-year period. The male to female ratio of peptic ulcer was 2.1:1. The annual incidences of duodenal and gastric ulcer were 2.3 per 1000 and 1.0 per 1000, respectively. The duodenal to gastric ulcer ratio was approximately 2:1 in both male and female patients. The incidence of peptic ulcer observed in the Faroe Islands is very high compared with other countries. The incidence of duodenal ulcer is of the same high magnitude as observed in Scotland, whereas the incidence of gastric ulcer is twice as high as generally found in Western countries and in accordance with the rates found in Arctic areas.     

Omeprazole versus placebo in duodenal ulcer healing

The study objective was to study the ulcer healing effects and safety of the proton pump inhibitor, omeprazole, given in a dose of 20 mg once daily before breakfast. The study design was a randomized, double-blind, multicenter comparison of omeprazole and placebo using endoscopy to assess ulcer healing after two or four weeks of therapy. One hundred fifty-three patients with endoscopically documented active duodenal ulcer were studied. One hundred two patients received omeprazole and 51 received placebo. Patients in both groups were similar with regard to age, sex, duration of disease, initial ulcer size, smoking history, and alcohol use. A per protocol analysis of healing rates showed a significant advantage for omeprazole (P<0.01) at both week 2 (41% vs 13%) and week 4 (75% vs 27%). Concomitant factors (including smoking and ulcer size) did not alter the significance of the differences in healing rates between omeprazole and placebo. Complete relief of day and night pain was more often achieved (P<0.01) in the omeprazole group. All-patients treated analyses for healing and pain relief gave results similar to the respective per protocol analyses. Omeprazole was well tolerated; fewer patients had clinical and laboratory adverse experiences in the omeprazole group than in the placebo group. Fasting serum gastrin levels increased with omeprazole therapy (mean 34.9 to 73.5 pg/ml) but exceeded the normal range (>150 pg/ml) in only 12.3% of patients. Two weeks after therapy was stopped, serum gastrin levels showed a decrease toward baseline but had not yet completely returned to pretreatment levels (mean 49.7 pg/ml). Observations from Europe and Australia of >90% healing of duodenal ulcers after four weeks of omeprazole therapy were not confirmed in this study. No single factor explains this difference. Considerable variation in the degree of suppression of acid secretion has been demonstrated with the 20-mg daily dose of omeprazole; it is possible that, in US populations, a greater degree of antisecretory effect may be required to achieve the healing rates observed in Europe and Australia. In conclusion, omeprazole was more effective than placebo in the treatment of active duodenal ulcer, as determined by ulcer healing and relief of pain, and was well tolerated in the short-term treatment of patients with duodenal ulcer.