肝源性溃疡的临床特点与治疗探讨

目的：惭肝后肝硬化患者消化性溃疡的临床特点，探讨小剂量心得安对肝源性溃疡愈合的影响。方法：肝源性溃疡４５例，观察其发病年龄、临床表现、溃疡部位、ＨＰ感染率、合并出血率及溃疡愈合率等特点。随机分为治疗组２３例，用心得安＋泰胃美口服治疗；对照组２２例，用维生素Ｂ６＋泰胃美口服治疗。另外选单纯性消化性溃疡２２便，作为对照２组，治疗方法与Ｂ组相同。结果：肝源性溃疡发病较单纯性消化性溃疡晚１０年，溃疡部位以     

心得安辅助治疗肝源性溃疡疗效观察

研究乙肝后肝硬化患者消化性溃疡的临床特点,探讨小剂量心得安对肝源性溃疡愈合的影响。肝源性溃疡124例,观察其发病年龄、溃疡部位、腹痛情况、临床表现、合并出血率、溃疡愈合率等特点。随机分为治疗组,用心得安+奥美拉唑治疗;对照组,用维生素B6+奥美拉唑治疗。另设单纯性消化性溃疡为对照2组,治疗方法与对照组相同。肝源性溃疡发病年龄较单纯性消化性溃疡晚10年,溃疡部位以胃溃疡居多、合并出血率高,心得安可明显提高肝源性溃疡愈合率与对照组具统计学意义(P相似文献   

不同方法对肝源性溃疡的疗效比较

[目的]比较不同方法对肝源性溃疡的疗效。[方法]将40例肝源性溃疡患者根据不同治疗方法分为A组、B组、C组,分别予以心得安+洛赛克、消心痛+洛赛克、单用洛赛克治疗,疗程均为28d。观察各组溃疡部位,治疗前后幽门螺杆菌(Hp)感染率,溃疡愈合情况及治疗后1年以内、3年以内上消化道大出血发生率。[结果]各组胃溃疡的发病者均明显多于球部溃疡者。各组治疗前后Hp感染率比较无差异(P0.05)。治疗后溃疡愈合率A组高于C组(P0.05);B组也高于C组,但2组比较差异无统计学意义(P0.05)。A组、B组在1年、3年以内上消化道出血率均明显低于C组(P0.01)。[结论]心得安或消心痛联合洛赛克治疗有助于肝源性溃疡的愈合,同时可减少肝硬化并发上消化道出血发病率。     

埃索美拉唑镁肠溶片联合胃复春治疗Hp阳性消化性溃疡临床观察

[目的]观察埃索美拉唑镁肠溶片联合胃复春治疗Hp阳性消化性溃疡的临床疗效。[方法]将Hp阳性的胃及十二指肠溃疡患者257例随机分为2组,观察组129例、对照组128例。对照组使用埃索美拉唑镁肠溶片+克拉霉素+阿莫西林,观察组在对照组基础上加服胃复春;治疗4周后统计分析2组患者的溃疡愈合率、Hp根除率、不良反应和治疗满意度。[结果]观察组患者溃疡愈合率、Hp根除率及治疗满意度均优于对照组,不良反应发生率低于对照组,2组之间以上指标比较,差异均有统计学意义(P0.05)。[结论]埃索美拉唑镁肠溶片联合胃复春治疗Hp阳性消化性溃疡方案能有效根除幽门螺杆菌,促进溃疡愈合,对Hp阳性消化性溃疡起到了较好的治疗效果。     

急诊内镜和泰胃美联合治疗消化性溃疡大出血的疗效观察

目的　观察急诊内镜和泰胃美联合治疗消化性溃疡大出血的疗效。方法　将 87例患者分为两组进行治疗 ,急诊内镜 +泰胃美组 (治疗组 ) 4 2例 ,奥美拉唑组 (对照组 ) 4 5例。结果　治疗组的休克发生率、输血量、急诊手术率和死亡率均低于对照组 ( P<0 0 5 )。治疗组的 2 4小时止血率为 83 3% ,高于对照组 ( P<0 0 5 ) ,48小时止血率为 88 1% ,与对照组相似 ( P>0 0 5 ) ,一周内再出血率为 11 9% ,低于对照组 ( P<0 0 5 )。所有病例未出现并发症。结论　急诊内镜联合泰胃美治疗消化性溃疡大出血 ,可提高 2 4小时止血率和降低再出血率和外科手术率     

心得安治疗肝源性溃疡疗效观察

肝硬化合并消化性溃疡称为肝源性溃疡(Ｈｅｐａｔｏｇｅｎｉｃｕｌｃｅｒ,ＨＵ),其发生率为非肝硬化者的2.5倍。在肝硬化者临床组中其发病率为18.6%,尸检组中为17.7%[1]。ＨＵ主要危险是并发出血。ＨＵ出血是肝硬化门脉高压病人发生上消化道出血的三大原因之一,仅次于食管胃底静脉曲张破裂和胃粘膜病变出血,临床上易误诊为食管胃底静脉曲张破裂出血[2]。为了探讨ＨＵ临床特点,我院1997年1月至1999年12月应用心得安治疗肝硬化合并消化性溃疡50例,观察了心得安对ＨＵ预后的影响。1　资料与方法11　研究对象　50例均为肝硬化合并消化性溃疡患者…     

老年人无痛性消化性溃疡并出血60例分析

目的通过分析老年无痛性溃疡伴出血的临床症状，溃疡部位及形态，胃内Hp感染；伴随疾病对治疗的影响因素，探讨老年人消化性溃疡并出血的治疗策略。方法收集1990～2003年住院病人中60岁以上老年经手术／胃镜证实的无痛性消化性溃疡并出血的病例资料，分析发病相关5个因素与溃疡出血的相关性。结果经过统计学处理显示老年人无痛性消化性溃疡并出血与溃疡部位、形态、Hp感染、高龄因素，伴随疾病有显著相关性。结论老年人无痛性消化性溃疡病的临床症状、发病部位、并发症、伴随疾病及病死率等方面均具一定特点。     

洛赛克与泰胃美治疗消化性溃疡对比观察

材料与方法:将内镜确诊的活动性消化性溃疡(PU)随机分为洛赛克(L)组46例,泰胃美(T)组40例,两组患者的性别,年龄、病程、溃疡平均面积及吸烟史等均具有可比性。L组给予洛赛克20mg,每日1次,睡前服,疗程2～4周;T组给予泰胃美800mg,每晚1次、疗程同上。治疗过程中不加用其他抗溃疡药物。治疗2周、4周后各复查胃镜1次,了解溃疡的愈合情况。 结果:L组28例DU服药2周愈合23例,4周愈合27例;18例GU2周愈合11例,4周愈合15例。     

肝源性溃疡的基础与临床

本文报告１１８例肝源性溃疡，内镜下肝硬化病人溃疡检出率为１２．５％，临床特点如下；１．发病年龄较一段性消化性溃疡晚十多岁；２．起病缓慢，症状不典型，病程长，漏诊率高；３．出血率高达４６．７％；４．胃酸明显高于正常人，胃泌素明显高于对照组，ＨＰ感染率升高不明显。５．难以治愈，而洛赛克有良好的疗效。     

老年人消化性溃疡

老年人消化性溃疡的部位、症状、愈合、再发以及防治措施均有一定的特点。随着人类寿命的显著延长,正确认识老年人的这一常见疾患有重要意义。本文综合近年来国外有关的资料。老年人消化性溃疡的特征发病部位:一般而言,胃角部溃疡发病率最高,但在老年人中胃体部溃疡明显增多,胃体上部和中部溃疡的发病率有随年龄增大而上升的倾向。有人报告老年人40.3%的胃溃疡见于胃体部。临床症状:随着年龄增大,胃溃疡和十二指肠患者腹痛,特别是剑突下疼痛的出现率减     

补托法对肝源性胃溃疡愈合质量的影响

目的:探讨补托法治疗肝源性胃溃疡愈合质量的临床疗效及安全性.方法:采用随机对照的方法,将中医辨证属于气虚血瘀证的肝源性胃溃疡患者随机分成治疗组和对照组,治疗组72例患者给予补托法代表方"托里透脓汤"+奥美拉唑+心得安治疗;对照组71例患者给予奥美拉唑+心得安治疗,疗程均为4 wk.观察两组肝源性胃溃疡患者的临床有效率,...     

奥美拉唑和克拉霉素及阿莫西林三联疗法治疗肝源性溃疡疗效观察

目的观察奥美拉唑、克拉霉素、阿莫西林三联疗法治疗肝源性溃疡的疗效。方法经胃镜确诊的肝源性溃疡患者58例,随机分为治疗组(31例)和对照组(27例)。两组患者均给予综合治疗。治疗组患者给予奥美拉唑20mg,口服,2次/d;克拉霉素500mg,口服,2次/d;阿莫西林1000mg,口服,2次/d。对照组单用奥美拉唑20mg,口服,2次/d。十二指肠溃疡治疗2周,胃溃疡治疗3周。疗程结束后,用内窥镜观察溃疡愈合情况。结果治疗组和对照组溃疡愈合率分别为87.0%和55.5%,差异有统计学意义(P<0.01);治疗后6个月和12个月,治疗组溃疡复发率分别为14.8%和18.5%,对照组分别为33.3%和40.0%,差异均有统计学意义(P<0.01)。结论奥美拉唑、克拉霉素、阿莫西林三联疗法治疗肝源性溃疡临床效果显著。     

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.     

Argon plasma coagulation versus injection sclerotherapy in peptic ulcer hemorrhage--a prospective, controlled study

BACKGROUND/AIMS: In Slovenia, the annual incidence of peptic ulcer hemorrhage is 118/100,000 inhabitants, with mortality up to 14%. Interventional endoscopy has largely reduced mortality in these patients. This study aims to evaluate the efficacy and safety of argon plasma coagulation and injection sclerotherapy in bleeding peptic ulcer. METHODOLOGY: A prospective, controlled study which includes 100 patients with peptic ulcer hemorrhage (male 63, female 37, av.age 57.1 years, SD+/-16, span 26-80; gastric ulcer 50 patients, duodenal ulcer 50 patients) in the period between 1.01.1999 and 15.05.2000 treated in our institution. The bleeding activity was determined according to the Forrest classification. Fifty patients were randomized to receive argon plasma coagulation (ARCO 2000 ES unit, group A) and in fifty patients injection sclerotherapy (sclerosing with diluted adrenalin 1:10,000 plus polidocanol 1%, group B) was performed. The groups did not differ with respect to age, sex, site, severity of bleeding, use of NSAID and additional diseases. RESULTS: Clinically and endoscopically diagnosed rebleeding occured in 7/50 patients (14%) in group A and in 9/50 patients (18%) in group B; p=0.78. The majority of rebleeding occured within 48 hours after endoscopic hemostasis, group A 4-/7 (57.1%), group B 7/9 (77.7%), p = 0.74. Repeated endoscopic hemostasis did not prove successful in 8 patients (group A 3/50, 6%, group B 5/50, 10%), p=0.71. Seven patients were treated operatively. The total mortality rate was 9% (9/100 patients, group A 4/50, 8%, group B 5/50, 10%), p>0.05. Only one patient died due to peptic ulcer hemorrhage, other 8 patients died due to concomitant diseases. CONCLUSIONS: Argon plasma coagulation seems to be an effective and safe alternative to other hemostatic modalities in peptic ulcer hemorrhage.     

Fasting serum gastrin and basal gastric acid secretion.

The gastric secretion of acid was examined 30 minutes basally (BAO) and in response to stepwise increasing doses of pentagastrin in subjects with (n = 51) and without (n = 40) peptic ulcer disease. None of them showed basal anacidity. Before insertion of the gastric tube, blood was taken for radioimmunological determination of the serum gastrin concentration (SG). A significant positive correlation was found between SG and BAO in the subjects without ulcer. This was mainly due to a close correlation in 20 healthy young volunteers. When BAO and SG was expressed as proportions of calculated maximal acid response (Vmax) and half maximal dose of pentagastrin (Km), respectively, the positive correlation between SG and BAO was improved and reached significance also in the individuals with peptic ulcer disease. The findings suggest that the serum concentration of gastrin plays a role in the basal gastric secretion.     

The effectiveness of (IgG-ELISA) serology as an alternative diagnostic method for detecting Helicobacter pylori infection in patients with gastro-intestinal bleeding due to gastro-duodenal ulcer.

OBJECTIVES: To establish the sensitivity, specificity, positive predictive value and negative predictive value of serology (IgG ELISA) as an alternative diagnostic method for Helicobacter pylori infection in patients with gastro-duodenal peptic ulcer and digestive hemorrhage. The diagnosis of Helicobacter pylori infection in these patients is difficult due to the low sensitivity of invasive tests and the need to discontinue treatment with proton pump inhibitors to perform a breath test with urea 13C or the detection of Helicobacter pylori antigens in feces. PATIENTS AND METHODS: We included 214 patients (164 men and 50 women) with an average age of 58 +/- 15 years, who were admitted to hospital due to upper gastro-intestinal bleeding caused by a gastro-duodenal peptic ulcer. The presence of Helicobacter pylori was established by means of gastric biopsy (fast urease test histology and/or culture) and a breath test with 13C-labeled urea. Serology was performed with the ELISA method (Pyloriset EIA-G by Orion Diagnostica). Positive Helicobacter pylori infection was accepted with any positive invasive method or breath test, and no infection was established if all invasive tests performed and the breath test with 13C-labeled urea were negative. We calculated the sensitivity, specificity, positive predictive value and negative predictive value of serology in the global series and in different subgroups of patients according to age (> 60 and < 40 years), recent exposure to non-steroidal anti-inflammatory drugs, type of endoscopic wound and history of gastro-duodenal peptic ulcer. RESULTS: 192 patients (89.7%) showed infection due to Helicobacter pylori. In the global series (n = 214) we obtained a sensitivity, specificity, positive predictive value and negative predictive value of 87.5, 54.5, 94.3 and 33.3%, respectively. Specificity was greater in the group not exposed to non-steroidal anti-inflammatory drugs (n = 110) as compared to the exposed group (n = 104), in the < 40 year old group (n = 28) with respect to the > 60 years group (n = 105), in the duodenal ulcer group (n = 141) with respect to the gastric ulcer group (n = 59), and in the group with a history of gastro-duodenal peptic ulcers (n = 92) as compared to the group without any of these past events (n = 122); nevertheless, no significant statistics were reached. CONCLUSIONS: IgG (ELISA) serology shows low specificity and a low negative predictive value in the diagnosis of Helicobacter pylori infection in patients with gastro-intestinal bleeding due to gastro-duodenal peptic ulcer. The diagnostic value of serology did not improve significantly when age, recent exposure to non-steroidal anti-inflammatory drugs, type of endoscopic wound or history of gastro-duodenal peptic ulcer was taken into consideration. We may consider that serology is not a good diagnostic method for the detection of Helicobacter pylori in patients with digestive hemorrhage caused by gastro-duodenal ulcer.     

Impact of non-steroidal anti-inflammatory drug and aspirin use on the prevalence of dyspepsia and uncomplicated peptic ulcer disease

BACKGROUND: Non-steroidal anti-inflammatory drug and aspirin (here collectively called NSAIDs) use is the second most common aetiologic factor for peptic ulcer disease and a major factor for peptic ulcer complications. The role of NSAIDs in the pathogenesis of uncomplicated peptic ulcer is less well understood and the interaction between NSAIDs and Helicobacter pylori infection on ulcer development is controversial. The aim of the present study was to examine the role of NSAIDs in the occurrence and clinical features of uncomplicated peptic ulcer disease. METHODS: A total of 1091 consecutive patients referred for open-access upper gastrointestinal endoscopy by general practitioners (GPs) were enrolled. The use of NSAIDs was gathered from a structured questionnaire completed by the patients and from patient files by GPs. The exclusion criteria were previous H. pylori eradication and gastric surgery, as well as symptoms and/or signs suggestive of acute gastrointestinal bleeding. RESULTS: Of the whole study group (n = 1091), 76 (7%) patients had a peptic ulcer. Thirty patients had an NSAID-use-associated peptic ulcer and 46 patients a non-NSAID-use peptic ulcer. Of patients with chronic gastritis (n = 599), 71% were H. pylori-positive and 108 used NSAIDs. Of those with chronic gastritis, 23 had an NSAID-use-associated peptic ulcer and 38 a non-NSAID ulcer. Of patients with normal gastric histology (n = 492), 75 patients used NSAIDs, 7 had an NSAID ulcer and 8 a non-NSAID ulcer. The only independent risk factor for peptic ulcer in patients using NSAIDs was H. pylori infection (odds ratio (OR) 3.1, 95% confidence interval (CI) 1.3-7.3), whereas dyspepsia (OR 1.0, 95% CI 0.4-2.4), male sex (OR 1.4, 95% CI 0.6-3.4), age (OR 1.0 per decade, 95% CI 0.8-1.3) and anaemia (OR 2.9, 95% CI 0.9-8.7) were not risk factors. In patients not using NSAIDs, independent risk factors for peptic ulcer were dyspepsia (OR 4.3, 95% CI 2.1-8.8), male sex (OR 2.0, 95% CI 1.1-2.8), age (OR 1.2 per decade, 95% CI 1.0-1.5), anaemia (OR 6.2, 95% CI 2.6-14.9) and H. pylori infection (OR 7.5, 95% CI 3.4-16.6). When comparing patients using NSAIDs or not, the OR of patients on NSAIDs for peptic ulcer was 2.7 (95% CI 1.5-5.0) among patients with chronic H. pylori gastritis (n = 424) and 5.3 (95% CI 1.8-15.0) among patients with normal gastric mucosa (n = 492). CONCLUSIONS: The use of NSAIDs increases the risk of peptic ulcer 3- and 5-fold in H. pylori-positive and H. pylori-negative patients, respectively. Dyspepsia is a poor predictor of peptic ulcer among patients using NSAIDs, and serologic H. pylori testing and treatment for chronic NSAID users is recommended.     

A new method for evaluating gastric ulcer healing by endoscopic ultrasonography

We observed the quantitative estimation of the transmural changes associated with gastric ulcer healing by using endoscopic ultrasonography (EUS). It was possible to diagnose the depth of ulcer by EUS. Forty-eight patients were divided into three treatment groups. Group A (n = 16) was treated with 800 mg cimetidine daily, group B (n = 22) with 20 mg omeprazole daily, and group C (n = 10) with 400 mg cimetidine + 300 mg gefarnate daily. EUS was performed before and after 2, 4, and 8 weeks of treatment. The groups were compared from the viewpoints of endoscopic findings and contraction rate of the length and the cross-sectional area of the ulcer in EUS pictures. The best healing of both the endoscopic and EUS findings was seen in group B. By estimating the changes inside the ulcer, EUS may provide useful information for choice of anti-ulcer agents.