消化性溃疡的抗幽门螺杆菌与抑酸维持治疗

近 2 0年来 ,由于幽门螺杆菌 (Ｈｐ)的发现 ,消化性溃疡的治疗发生了巨大的变革。首先是消化性溃疡发病机制的新观念 (Ｈｐ是消化性溃疡的重要致病因素 ) ,治疗上的新方法 (根除Ｈｐ可以治愈溃疡病 )。此外 ,良好的治疗效果改变了溃疡病的自然病程 ,出现了“四少” :①合并症少 ;②复发者少 ;③需要抑酸维持治疗者少 ;④需要手术治疗者少。本院1975～ 1980年间因溃疡病手术者占同期普外科手术人数的 13.4 % ,1995～ 2 0 0 0年则下降至 2 .4 %。这种下降趋势还可能发展。当今消化性溃疡的治疗 ,关键问题有 :①Ｈｐ根除治疗 ;②什么情况下需要…     

Gastric retention in peptic ulcer disease

The saline load test is a popular method to demonstrate gastric retention. This technique, however, does not permit evaluation of volumes contributed by gastric secretion. We have studied 11 normal subjects and 7 patients with pyloric outlet obstruction using a dyedilution technique. We measured simultaneously rates of water secretion, fractional emptying rates, total intragastric volumes, and the fractions of gastric volume contributed by gastric secretion both during fasting and following a 250-ml water load. Total intragastric volume was significantly increased in patients with outlet obstruction compared to normal subjects both during fasting and following the water load (P<0.01). This increase resulted from significantly increased water secretion (P<0.01) combined with significantly decreased gastric emptying (P<0.01). Thus, gastric retention produced in patients with outlet obstruction by delayed emptying appears to be magnified by gastric hypersecretion of water. These data in no way invalidate the use of the saline load test in the diagnosis of gastric retention states, but help define the role of gastric secretion in the residual volumes measured following the load.Supported in part by the Department of Defense, USUHS Grant C08300 and the Department of the Navy Clinical Investigation Program 7-06-952     

Gastric cyto-secretory correlations in peptic ulcer.

BACKGROUND/AIMS: Maximal acid output, parietal cell mass, serum pepsinogen A (PGA) and total peptic activity (TPA) in gastric juice were studied and compared in duodenal ulcer and in different gastric ulcer sites. METHODOLOGY: 152 peptic ulcer patients were studied. 64 cases of gastric ulcer (GU) were subdivided according to Johnsons's classification and compared with 88 duodenal ulcer (DU) patients diagnosed for the first time. 40 normal subjects were studied as controls. RESULTS: Duodenal ulcer is characterized by normo-hyperparietalism, normo-hyperchloridria and an increase in peptic activity. In cases of GU, such correlation is not only conditioned by the topographic seat of the ulcer, but by the histological condition of the gastric mucosa too. Body GU is characterized by hypoparietalism, hypochloridria, hyper-PGA and hyper-TPA. Pre-pyloric GU is characterized by normo-hyperparietalism, normo-hyperchloridria, hyper-PGA and hyper-TPA. In GU the cyto-secretory behavior is characterized by the histology of the body mucosa with prevalence of preatrophic-atrophic gastritis in case of body GU and prevalence of superficial gastritis in case of GU type II and III. CONCLUSIONS: The results confirm the anatomic-functional analogy between DU and type II and III GU. If considered from the functional point of view, these conditions differ considerably from those that are characteristic of type I GU (as they closely follow the chronic gastritis pattern).     

Acid inhibition and peptic ulcer bleeding

Peptic ulcer bleeding is one of the most common emergency situations in medicine. Combined pharmacological and endoscopic therapy together with emerging interventional radiological procedures are successfully treating peptic ulcer disease, reserving surgical procedures for only a small portion of patients unresponsive to 'conventional' therapy. Technological advancement has seen a great improvement in the field of endoscopic treatment in the form of various methods of hemostasis. However, pharmacological therapy with proton pump inhibitors still plays the central role in the peptic ulcer bleeding treatment algorithm.     

Gastric “freezing” for peptic ulcer

Summary In our clinical trials of gastric freezing for treatment of peptic ulcer, we have found on gastroscopic examination some increase in friability of the gastric mucosa. Microscopic examination of biopsy specimens disclosed no significant abnormalities early or late after freezing. There was an early decrease in motility after freezing, and in some instances an early decrease in the 12-hr, overnight secretion of free hydrochloric acid. However, there was no persistent, significant change apparent after gastric freezing, as evaluated by these anatomic and physiologic studies.     

抑酸剂在消化性溃疡治疗中的作用

尽管消化性溃疡患者的胃酸分泌与正常人存在较大的重叠,但在胃黏膜屏障功能受到损害的前提下,胃酸是引起胃十二指肠黏膜损伤的最主要因素,抑制胃酸分泌可促使溃疡愈合."无酸,无溃疡"的观点依然是正确的.     

Surgical treatment of peptic ulcer

Despite a decreasing number of operations for ulcer, there are many patients who require definitive treatment. If an operation is required for duodenal ulcer, vagotomy of some type is part of the treatment, and in gastric ulcer resection with or without vagotomy is required. Extended proximal gastric vagotomy can be performed in the majority of patients, excluding those who are unstable or have severe concomitant diseases. In cases of urgent surgery for hemorrhage or perforation, the surgical procedure must be selected individually. Although the role of traditional operations is well established, there is increasing interest in laparoscopic approaches. However, because there is a diminishing of elective surgery for ulcer, it is unlikely that these new procedures may be evaluated as operations were evaluated in the past.