胃镜检出老年消化性溃疡124例

目的:探讨老年消化性溃疡的临床特点.方法:回顾性分析我院内镜中心2007-01/2008-10经胃镜检出的的老年消化性溃疡患者,并与同期行胃镜检查的60岁以下的消化性溃疡患者进行对比.结果:老年组124例,胃溃疡61例,十二指肠球部溃疡51例,复合溃疡12例;中青年组100例,胃溃疡29例,十二指肠球部溃疡64例,复合溃疡7例.两组相比胃溃疡有显著差异( P<0.01).老年组胃体溃疡占胃溃疡的36.1%,直径>2cm的溃疡占29.5%,并发症以上消化道出血为主,占43.5%,均较中青年组有显著性差异( P<0.05).结论:老年消化性溃疡症状不典型,溃疡部位由幽门向贲门推移,且胃溃疡比十二指肠球部溃疡多,溃疡面积较大,合并症多且较严重.     

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。     

黛力新联合胃电起搏治疗在功能性消化不良治疗中的疗效

目的:探讨黛力新联合胃电起搏治疗胃功能性消化不良患者的疗效。方法:将功能性消化不良患者120例分成2组各60例。实验组予以黛力新联合胃电起搏治疗,对照组予以黛力新联合莫沙必利治疗。治疗前后进行胃电图检查和症状评估。结果:黛力新联合胃电起搏治疗后症状积分明显下降(P0.01),症状明显改善,治疗后患者餐前胃电慢波百分比与治疗前相比无显著差异,餐后胃电慢波百分比则显著高于治疗前(P0.01),并明显高于对照组(P0.05);2组治疗后HAMD、HAMA评分均有明显降低。结论:黛力新联合胃电起搏治疗能改善功能性消化不良患者的胃电节律紊乱和症状。     

1997年～2006年72125例消化性溃疡和上消化道肿瘤胃镜检出资料分析

目的 研究湖北十堰地区部分人群近10年来消化性溃疡和上消化道肿瘤胃镜检出数据的变化.方法 收集本院1997年1月～2006年12月行胃镜检查的部分湖北十堰地区患者7212.5例,对确诊为消化性溃疡和食管癌、胃癌的患者进行分析.结果 2000年～2006年十二指肠球部溃疡胃镜检出率较1997～1999年明显下降(P<0.01),十二指肠球部溃疡患者平均年龄为40.1岁,男女比为4.7:1.0.胃溃疡检出率近10年无明显变化(P>0.05),胃溃疡患者平均年龄为46.8岁,男女比为5.8:1.0.消化性溃疡冬春两季的检出率明显高于夏秋两季(P<0.01).食管癌和胃癌的检出率近10年无明显差异(P>0.05).结论 湖北十堰地区近10年来十二指肠球部溃疡胃镜检出率明显下降,至2002年维持低水平,这可能与我们正规有效地进行根除幽门螺旋杆菌和强有力抑制胃酸分泌治疗有关,而食管癌和胃癌检出率仍较高.     

消化不良症状的鉴别诊断意义

消化不良是一种极常见症状,一般诊断主要根据病史和临床表现。新近有人用计算机研究发现:消化性溃疡和功能性消化不良患者的临床表现在某些方面与传统教科书上所描述的典型表现并不一致,因而造成了临床上消化不良患者的误诊。本文分析了221例患者的临床表现,旨在确定是否能根据一些特殊的症状或症状群将原发性消化不良与消化性溃疡和胆石症作鉴别。病例:113例原发性消化不良(内镜证实无溃疡,亦无其它消化道疾病的临床、生化及X线表现);55例有症状且经内镜证实的十二指肠溃疡和胃溃疡(前者32例,后者23例);53例因胆痛和服石症住院的患者,剖腹手术时除胆石外未见其它病变。     

功能性消化不良血浆胃动素及体表胃电图临床研究

目的研究血浆胃动素浓度及体表胃电图与功能性消化不良的关系并探讨功能性消化不良的病因．方法功能性消化不良患者及健康志愿者各30例病例组按国际诊断标准选择[1]，并分为动力障碍样型、溃疡样型、反流样型及复合型．对所有受检者空腹、餐后血浆胃动素浓度及同步体表胃电图进行综合分析，并对10例动力障碍样型患者服用促动力药后随访．结果①对30例FD患者分型，动力障碍样型患者空腹血浆MTL水平明显低于对照组（P＜0．01）．②30例FD患者空腹、餐后胃电节律紊乱率均明显高于对照组（P＜0．001）；其餐后胃电振幅较空腹时无明显增加且仍低于对照组（P＜0．01）．结论血浆胃动素浓度异常及胃电活动异常与功能性消化不良关系密切     

心理状态变化与自主神经功能改变及胃电节律紊乱在功能性消化不良中的相互关系

目的:探探讨在功能性消化不良(functional dyspepsia,FD)患者中心理状态变化,自主神经功能改变和胃电节律紊乱之间的相互关系.方法:按罗马Ⅲ标准前瞻性分析FD患者85例和正常人30例的HAMD他评抑郁量表,HAMA他评焦虑量表及SCL-90项症状自评量表,同步检测自主神经功能变化及胃电节律紊乱情况.结果:FD患者普遍存在心理状态异常及自主神经功能损害和胃电节律紊乱,与正常人相比均有显著性差异(P<0.01);心理状态变化对自主神经功能改变有关且影响很大(P<0.01,C=0.4908),后者对前者的改变及影响程度较低(P<0.05,C=0.2519):自主神经功能改变与胃电节律紊乱有关且相关性相同(P<0.01,C= 0.4279);心理状态异常与胃电节律紊乱相关性无统计学意义(P>0.05,C=0.1866).结论:FD患者心理状态异常与自主神经功能改变的关系最密切,自主神经功能变化与胃电节律紊乱之间有一定关系,心理状态异常与胃电节律紊乱之间无直接关系.     

潘托拉唑三联疗法与奥美拉唑三联疗法治疗幽门螺杆菌相关性消化性溃疡的对比研究

目的:研究潘托拉唑治疗消化性溃疡及根除幽门螺杆菌(HP)的疗效和安全性.方法:将经过胃镜和病理学检查证实了的消化性溃疡患者随机分成潘托拉唑组(治疗组)和奥美拉唑组(对照组).其中治疗组60例,应用潘托拉唑、羟氨苄青霉素和甲硝唑治疗;对照组57例,应用奥美拉唑、羟氨苄青霉素和甲硝唑治疗.停药后均复查胃镜观察溃疡愈合情况以及HP根除情况.结果:两组胃溃疡的愈合率分别为92.3%和95.4%,HP根除率分别为92.3%和90.9%;十二指肠溃疡的愈合率分别为97.1%和94.3%,Hp根除率分别为91.2%和94.3%,两组比较差异无显著性(P>0.1).各项症状的改善情况两组相似(P>0.1).治疗期间两组均有良好的耐受性.结论:潘托拉唑对消化性溃疡有很高的治愈率,以它为主的三联疗法可达到很高的HP根除率,对消化性溃疡的疗效与奥美拉唑相当,不良反应极少,患者耐受性、依从性好,是一种有广泛应用前景的新型质子泵抑制剂.     

功能性消化不良患者胃感觉功能与早饱症状的关系

目的了解功能性消化不良(functionaldyspepsia,FD)患者的胃感觉功能与早饱症状的关系。方法将48例功能性消化不良患者按照是否存在早饱症状分为早饱组和非早饱组,其中早饱组24例(男女各12例),非早饱组24例(男女各12例)。运用饮水负荷试验测定胃感觉功能,并与20例对照组的胃感觉功能进行比较。刚出现上腹部饱足感时的饮水量为初次饱足阈值,受试者出现完全饱足或因上腹部症状不能继续饮水时的饮水量即最大饱足阈值。结果功能性消化不良患者初次饱足阈值和最大饱足阈值均较对照组显著降低(433ml±60.2ml比503ml±32.4ml,P<0.01和784ml±90.8ml比1030ml±84.8ml,P<0.01);功能性消化不良患者早饱组和非早饱组间初次饱足阈值和最大饱足阈值比较无明显差别(430ml±61.7ml比437ml±59.6ml,P>0.05和779ml±95.1ml比788ml±87.9ml,P>0.05)。50%的功能性消化不良患者初次饱足阈值降低,75%的患者最大饱足阈值降低。结论部分功能性消化不良患者确实存在胃感觉过敏,功能性消化不良患者胃感觉功能与早饱症状之间无明显关系。     

奥美拉唑镁肠溶片与奥美拉唑胶囊治疗消化性溃疡的临床随机对照研究

目的　验证奥美拉唑镁肠溶片与奥美拉唑胶囊治疗消化性溃疡的生物等效性及评价其不良反应。方法　采用随机对照和开放试验的方法治疗经胃镜检查证实的消化性溃疡共 171例 ,其中奥美拉唑镁肠溶片组 (试验组 ) 68例 ,胃溃疡 2 1例 ,十二指肠溃疡 47例 ;奥美拉唑胶囊组 (对照组 ) 67例 ,其中胃溃疡 2 1例 ,十二指肠溃疡 46例 ;开放试验组 3 6例 ,其中十二指肠溃疡 2 9例 ,胃溃疡 7例。结果　试验组中胃溃疡的愈合率和总有效率分别为 80 9%和 10 0 %十二指肠溃疡的愈合率和总有效率分别为87 2 %和 97 8% ;对照组中胃溃疡的愈合率和总有效率为 85 7%和 95 2 % ,十二指肠溃疡的愈合率和总有效率为 84 7%和 97 8% ;开放试验组中胃溃疡的愈合率和总有效率均为 10 0 0 %十二指肠溃疡的愈合率和总有效率分别为 86 2 %和 10 0 % ;试验组中疼痛消失率及其他消化道症状的消失率在胃溃疡为 95 2 %和 89 0 %在十二指肠溃疡则为 97 8%和 98 3 % ;对照组中疼痛及其他消化道症状的消失率在胃溃疡为 95 2 %和 92 7% ,在十二指肠溃疡为 97 8%和 98 7%。两组在愈合率、总有效率、疼痛消失率和其他消化道症状消失率方面相比均无显著差别 (P >O 0 5 )。两组在治疗过程中均未见明显的不良反应。结论　奥美拉唑镁肠溶片与奥     

Non-ulcer dyspepsia

Opinion Statement  Non-ulcer dyspepsia (NUD) refers to pain or discomfort centered in the upper abdomen that is not explained by the findings at esophagogastroduodenoscopy or other routine testing. To manage this condition:

1 Nomenclature of dyspepsia,dyspepsia subgroups and functional dyspepsia: Clarifying the concepts

There is international agreement that dyspepsia refers to pain or discomfort centred in the upper abdomen. However, the term ‘discomfort’ has been variably defined. While other symptoms may often be simultaneously present, gastro-oesophageal reflux disease can usually be clearly distinguished by the presence of predominant heartburn. Dyspepsia is a frequent reason for consultation in primary care and in gastrointestinal practice. With the widespread availability and utilization of endoscopy, it has become evident that a structural (or organic) explanation is found in only a minority of patients presenting with dyspepsia. Operationally, functional dyspepsia is defined as persistent or recurrent dyspepsia for 3 or more months in the absence of a clinically identifiable structural disease causing the symptoms. It has been proposed, based on symptoms, that functional dyspepsia be subdivided into symptom subgroups to promote patient homogeneity. The initially proposed ‘clustering’ of symptoms into ulcer-like and dysmotility-like functional dyspepsia has proved a dismal failure because of the considerable overlap observed, the lack of stability over time and the failure to identify robust pathophysiological abnormalities or responses to therapy. A subcategorization based upon the most bothersome symptom is theoretically more attractive but needs to be prospectively and rigorously tested.     

Uninvestigated dyspepsia

Opinion statement  

Nonulcer dyspepsia

Nonulcer dyspepsia is a common condition in clinical practice. It is a heterogeneous disorder, and no single therapeutic agent is effective in all patients. The treatment of nonulcer dyspepsia is still dissatisfactory. Eradication of Helicobacter pylori organisms has a limited role and little effect. Antisecretory therapy has a modest effect in alleviating symptoms. Prokinetic agents may be effective, but selection bias in the trials performed to date may exaggerate their benefit. Partial 5-HT₄ agonists stimulate gastric emptying and may also affect gastric accommodation. They are promising but need further study. Data are limited on 5-HT₃ antagonists and hypnotherapy. New treatment approaches are necessary for this common and often chronic condition.     

Functional dyspepsia

Functional dyspepsia is defined as persistent or recurrent upper abdominal pain or discomfort not explained by structural or biochemical abnormalities. In about half of the patients who present to their practitioner with chronic dyspepsia, no underlying disease is established after clinical investigation. Many clinical trials have been performed to demonstrate a certain relationship between functional dyspepsia and several pathogenic mechanisms like dysmotility, Helicobacter pylori infection, acid output and hypersensitivity to distension. Unfortunately, the conclusions of those studies are conflicting. Short-term follow-up, lack of consensus about diagnostic criteria for functional dyspepsia and unvalidated symptom measures make it difficult to interpret their results.     

Managing dyspepsia

The prevalence of dyspepsia in the general population is as high as 40%, and its management represents a considerable financial burden to the health care system. Causes of dyspepsia amenable to medical therapy include peptic ulcer and functional dyspepsia, and testing for Helicobacter pylori and treating positive individuals is beneficial in both conditions. Individuals presenting for the first time with uninvestigated dyspepsia, age greater than 50 years, or alarm features require upper gastrointestinal (GI) endoscopy to exclude gastroesophageal malignancy. Upper GI endoscopy for younger individuals without alarm features is not cost-effective compared with the “test and treat” approach. Test and treat and empirical acid-suppression using a proton pump inhibitor (PPI) have similar costs and effects. Recent evidence suggests that empirical acid suppression commencing with antacids is as effective as PPI. Screening and treatment of H. pylori in PPI users and the community may reduce the costs of managing dyspepsia.     

Idiopathic dyspepsia

Opinion statement Idiopathic dyspepsia refers to pain and/or discomfort perceived in the epigastrium that is not secondary to organic, systemic, or metabolic diseases. Symptoms may overlap with those of gastroesophageal reflux disease and irritable bowel syndrome. Gastrointestinal motor disorders, hypersensitivity to mechanical or chemical stimuli, and psychosocial factors can act individually or in concert to induce the symptoms of dyspepsia. Accordingly, there is no single therapy, and treatment must be individualized. Eradication of Helicobacter pylori infection rarely achieves symptom improvement. Treatment of idiopathic dyspepsia should begin by reassuring the patient about the benign nature of the syndrome and educating them on the knowledge that has been achieved in recent years regarding potential causes of the syndrome. Both prokinetic and antisecretory drugs have been reported to improve dyspeptic symptoms, but results are not completely convincing. Although well-designed studies demonstrate superiority of proton pump inhibitors over placebo, it should be noted that patients with nonerosive gastroesophageal reflux disease were invariably included; when these patients are excluded, the benefit of antisecretory medications is questionable. We suggest that patients with idiopathic dyspepsia be initially treated according to the predominant symptom. Those with epigastric pain/burning should receive a trial with standard doses of proton pump inhibitors for 4 to 8 weeks, whereas prokinetic patients should be prescribed at recommended doses for similar periods of time to patients with nonpainful dyspeptic symptoms such as posprandial fullness, early satiety, nausea, or vomiting. Nonresponders may benefit from combination therapies or short trials with higher doses of drugs. Visceral analgesics and antidepressants can also be prescribed alone orin combinations with other therapeutic strategies. Recent studies demonstrate utility for psychologic therapy and hypnotherapy, although truly controlled studies are difficult in this area. Herbal medicines deserve further evaluation.