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.     

十二指肠溃疡患者夜间酸突破现象临床研究

目的　观察十二指肠溃疡患者夜间酸突破 (NAB)现象 ,以探讨不同治疗方案对NAB的控制效果。方法　将 2 0 0 2 - 0 6～ 2 0 0 3- 0 4大连医学院附属二院消化科 4 0例十二指肠溃疡患者随机分为 4组 ,每组 10例 ,A组 :口服奥美拉唑 2 0mg ,每日 2次 ,法莫替丁 2 0mg睡前口服 ;B组 :口服奥美拉唑 2 0mg ,每日 2次 ;C组 :口服奥美拉唑 2 0mg ,每日 1次 ,法莫替丁 2 0mg睡前口服 ;D组 :口服奥美拉唑 2 0mg ,每日 1次。用药 5d ,于第 5天监测 2 4h胃内pH值。结果　 (1)A组患者没有NAB发生 ,B、C组均分别只有 1例发生 ,D组发生 6例。A、B、C 3组显著低于D组 (P <0 0 5 )。 (2 ) 4组患者的平均胃内 pH值、平均中位pH、夜间平均胃内 pH、和夜间平均中位 pH比较 ,A组显著高于其他各组 (P <0 0 5 ) ;而B组与C组明显高于D组 (P <0 0 5 ) ,B、C组之间差异无显著性 ;D组各项指标均低于其他各组 (P <0 0 5 )。 (3)A组 pH <4 0的时间占总检测时间的百分比、夜间 pH <4 0的时间占夜间检测时间的百分比均显著低于其它各组 (P <0 0 1) ,而B组与C组均明显低于D组 (P <0 0 5 ) ,B、C组之间相比差异无显著性 ;D组明显高于其它各组 (P <0 0 5 )。结论　十二指肠溃疡患者治疗过程中单用奥美拉唑多发生NAB ,改变奥美拉唑用     

雷贝拉唑与奥美拉唑对十二指肠溃疡患者症状的短期疗效

目的　评价短期应用雷贝拉唑和奥美拉唑对十二指肠溃疡 (DU)患者症状的治疗作用及其安全性。方法　多中心、随机、双盲、平行对照研究。将活动期DU患者随机分为雷贝拉唑 (1 0mg/d)治疗组和奥美拉唑 (2 0mg/d)对照组。 2组均服药 7d。记录治疗前和用药期间的腹痛、反酸、腹胀和嗳气症状的变化及有无不良反应出现。结果　治疗组和对照组分别完成了 1 0 8例和 1 0 3例患者的观察。治疗组的腹痛平均消失天数为 (3 1± 1 7)d ,与对照组 (3 2± 1 8)d相同。治疗组和对照组服药期间每天的腹痛消失率无明显差异。用药第 1天时治疗组的腹痛缓解率为 56 % ,明显高于对照组的 33 % (P <0 0 5) ,其余各天内 2组间无差异。治疗组患者第 7天的反酸消失率为 1 0 0 % ,明显高于对照组的 83 % (P <0 0 5)。 2组患者的每天腹胀和嗳气的消失率差异均无显著性。 2组均无不良反应发生。结论　雷贝拉唑及奥美拉唑均对DU患者的症状具有良好的治疗作用 ,而雷贝拉唑在服药第 1天对腹痛及第 7天对反酸的缓解作用更为明显。雷贝拉唑短期应用具有良好的安全性     

十二指肠溃疡患者夜间酸突破现象分析

目的探讨十二指肠溃疡患者(DU)的夜间酸突破(NAB)现象及其与幽门螺杆菌(Hp)感染之间的关系.方法十二指肠溃疡患者随机分为五组,每组8例,分别接受A组静脉注射奥美拉唑40 mg,每日2次;B组静脉注射奥美拉唑40 mg,每日1次;C组口服奥美拉唑20 mg,每日2次;D组口服奥美拉唑20 mg,每日1次;E组静脉注射西米替丁600 mg,每日2次.均用药5 d并于第5天早上8时起连续24 h监测其胃内pH值.结果五组患者的平均胃内pH、平均中位pH、夜间平均胃内pH和夜间平均中位pH均有不同程度升高,A组升高明显,显著高于B、D、E组,差异有显著性(P＜0.05);B、D、E组夜间pH＜4.0的时间占夜间监测时间的百分比显著高于A、C组(P＜0.05);五组分别有0例(A组,0%)、4例(B组,50.0%)、1例(C组,12.5%)、4例(D组,50.0%)、3例(E组,37.5%)患者发生NAB;奥美拉唑2次用药组(包括静脉和口服用药组)仅有1例NAB发生(6.3%),显著低于1次用药组(包括静脉和口服用药组,56.3%,P＜0.05);合计18例Hp阴性者中有10例(55.6%)发生NAB,22例Hp阳性者中只有3例(13.6%,P＜0.05).结论 DU患者中,中国人的NAB发生率低,NAB与奥美拉唑剂量、用药方法及Hp感染相关.     

奥美拉唑对十二指肠溃疡患者胃液表皮生长因子浓度的影响

目的 观察奥美拉唑（Ｏｍｅ）愈合十二指肠溃疡（Ｄｕ）对胃液表皮生长因子（ＥＧＦ）浓度的影响。方法 ５８例Ｈｐ阳性Ｄｕ患者随机分为三组：奥美拉唑（Ｏｍｅ）＋胶体铋剂（ＣＢＳ）＋羟氨苄青霉素（Ａｍｏ）组，雷尼替丁（Ｒａ）＋ＣＢＳ＋Ａｍｏ组和ＣＢＳ＋Ａｍｏ组，服药４周（Ｏｍｅ、Ｒａ和ＣＢＳ分别服４周，Ａｍｏ２周）。于治疗前、后分别测定空腹血清胃泌素和胃液ＥＧＦ浓度并与１２例Ｈｐ阴性健康对照组比较。结果：     

兰索拉唑针剂治疗十二指肠球部溃疡出血的多中心临床研究

目的 探讨兰索拉唑针剂治疗十二指肠球部溃疡出血的临床效果及安全性.方法 采用多中心、随机、阳性药物、平行对照研究.将2005年4月-11月收集的216例经胃镜证实的十二指肠球部溃疡出血患者随机分为两组,试验组110例给予兰索拉唑(商品名:奥维加)30 mg、对照组106例给予奥美拉唑钠(商品名:洛赛克)40 mg静脉滴注,每12 h 1次,连续5 d,结果共有212例患者可供疗效评价及安全性评价.试验组的临床显效率为73.39%,总有效率为95.41%,对照组的临床显效率为81.55%,总有效率为95.15%,两组间差异无统计学意义(P＞0.05).止血时间试验组为(31.90±18.58)h,对照组为(28.00±18.31)h;止血率试验组为98.17%,对照组为99.03%,两组问差异均无统计学意义(P＞0.05).两组不良反应主要为白细胞减少、转氨酶轻度升高和皮疹(P＞0.05).结论 兰索拉唑针剂是治疗十二指肠球部溃疡出血有效且安全的药物.     

洛赛克、克拉霉素、替硝唑三联疗法治疗愈合的十二指肠球部溃疡患者组织成熟度的观察

目的观察洛赛克、克拉霉素、替硝唑三联疗法治疗已愈合的十二指肠球部溃疡(DU)患者“再生”黏膜组织成熟度的变化。方法将64例幽门螺杆菌(HP)感染的活动性DU患者随机分成2组:洛赛克组(36例)应用洛赛克20mg+克拉霉素500mg+替硝唑500mg,每日2次,共用1周;雷尼替丁组(28例)采取雷尼替丁150mg每日2次+阿莫西林500mg每日3次+甲硝唑400mg每日3次,共4周。结果洛赛克组和雷尼替丁组分别有3例和2例失访。洛赛克组和雷尼替丁组溃疡愈合率分别为90.91%(30/33)和69.23%(18/26),P<0.05;洛赛克组和雷尼替丁组HP根除率分别为93.94%(31/33)和65.38%(17/26),P<0.05;再生黏膜组织成熟度洛赛克组30例有22例为良(73.33%),而雷尼替丁组18例中仅6例(33.33%)为良,P<0.01。结论洛赛克、克拉霉素、替硝唑1周三联疗法的HP根除率高,再生黏膜组织成熟度优于含雷尼替丁组方案。     

十二指肠溃疡穿孔的腹腔镜外科处理

目的：探讨应用腹腔镜技术对十二指肠溃疡穿孔诊治的效果。方法：1995年以来对25例十二指肠溃疡穿孔并发弥漫性腹膜炎患者采用腹腔镜检查明确诊断，并在镜下行穿孔缝合及大网膜覆盖修补术，其中6例同时行壁细胞迷走神经切断术(PCV)，术后留置腹腔引流，并用H2受体拮抗剂、质子泵抑制剂或联用抗幽门螺杆菌治疗。结果：25例患者全部在腹腔镜下完成手术，无手术并发症，平均手术时间55min，平均住院时间6d，术后随访6～36个月，无溃疡复发。结论：腹腔镜技术应用于十二指肠溃疡穿孔的治疗，创伤小、痛苦少、并发症低，而且能够获得与开腹手术同样的临床疗效。     

Successful treatment of life-threatening bleeding from a duodenal posterior bulb peptic ulcer by an over-the-scope-clip

Bleeding of peptic ulcer at the posterior duodenal bulb still is a particular endoscopic challenge with increased risk of treatment failure and worse outcome.In this article,we report successful treatment of an actively bleeding peptic ulcer located at the posterior duodenal wall,using an over-the-scope-clip in the case of a 54-year-old male patient with hemorrhagic shock.Incident primary hemostasis was achieved and no adverse events occurred during a follow-up of 60 d.     

Endoscopic biopsy： Duodenal ulcer penetrating into liver

TO THE EDITOR We have read with interest the recent report by E Kayacetin and S Kayacetin of Gastric ulcer penetrating to liver diagnosed by endoscopic biopsy[1] since we diagnosed the duodenal ulcer which penetrated into liver similarly. This is a rather unusual case because of the fifth case in the literature and responding to medical therapy.     

瑞巴派特治疗十二指肠溃疡的疗效观察

为了探讨瑞巴派特治疗十二指肠溃疡的疗效,将102例十二指肠溃疡患者随机分为A、B、C3组,A组给予瑞巴派特+奥美拉唑+阿莫西林+克拉霉素;B组给予铝碳酸镁+奥美拉唑+阿莫西林+克拉霉素;C组给予硫糖铝+奥美拉唑+阿莫西林+克拉霉素.结果 显示在总S期和S2期获得率及溃疡直径减小程度等方面A组明显高于B、C两组.瑞巴派特是促进溃疡愈合疗效较高的药物.     

Life threatening bleeding from duodenal ulcer after Roux-en-Y gastric bypass: Case report and review of the literature

Acute upper gastrointestinal bleeding is a rare, but serious complication of gastric bypass surgery. The inaccessibility of the excluded stomach restrains postoperative examination and treatment of the gastric remnant and duodenum, and represents a major challenge, especially in the emergency setting. A 59-year-old patient with previous history of peptic ulcer disease had an upper gastrointestinal bleeding from a duodenal ulcer two years after having a gastric bypass procedure for morbid obesity. After negative upper endoscopy finding, he was urgently evaluated for gastrointestinal bleeding. At emergency laparotomy, the bleeding duodenal ulcer was identified by intraoperative endoscopy through gastrotomy. The patient recovered well after surgical hemostasis, excision of the duodenal ulcer and completion of the remnant gastrectomy. Every general practitioner, gastroenterologist and general surgeon should be aware of growing incidence of bariatric operations and coherently possible complications after such procedures, which modify patient’s anatomy and physiology.     

Management of duodenal ulcer bleeding resistant to endoscopy:Surgery is dead!

Acute massive duodenal bleeding is one of the most frequent complications of peptic ulcer disease.Endoscopy is the first-line method for diagnosing and treating actively bleeding peptic ulcers because its success rate is high.Of the small group of patients whose bleeding fails to respond to endoscopic therapy,increasingly the majority is referred for embolotherapy.Indeed,advances in catheter-based techniques and newer embolic agents,as well as recognition of the effectiveness of minimally invasive treatment options,have expanded the role of interventional radiology in the management of hemorrhage from peptic ulcers over the past decade.Embolization may be effective for even the most gravely ill patients for whom surgery is not a viable option,even when extravasation is not visualized by angiography.However,it seems that careful selection of the embolic agents according to the bleeding vessel may play a role in a successful outcome.The role of the surgeon in this clinical sphere is dramatically diminishing and will certainly continue to diminish in ensuing years,surgery being typically reserved for patients whose bleeding failed to respond all previous treatments.Such a setting has become extremely rare.     

根除幽门螺杆菌对出血性十二指肠溃疡自然病程影响的3年随访研究

目的：探讨根除幽门螺杆菌（Ｈｐ）对出血性十二指肠溃疡自然病程的影响。方法：选择胃镜证实的出血性十二指肠溃疡病人１３６例，均有Ｈｐ感染（胃粘膜Ｇｉｅｍｓａ染色和１４Ｃ尿素呼吸试验二项均阳性）。予奥米拉唑２０ｍｇ，每日２次；羟氨苄青霉素７５０ｍｇ，每日２次；甲硝唑４００ｍｇ，每日３次，疗程２周。疗程结束后４周复查胃镜和Ｈｐ，溃疡愈合者分Ａ组（Ｈｐ根除）和Ｂ组（Ｈｐ未根除）进入随访阶段，随访观察３年。结果：溃疡愈合１２４例（９１２％），Ｈｐ根除１１１例（８１６％）；Ｈｐ根除的溃疡愈合率为９９１％（１１０／１１１），显著高于Ｈｐ未根除的５６％（１４／２５，Ｐ＜０００５）；Ｂ组１年内溃疡复发率达１００％，显著高于Ａ组８３％（Ｐ＜００５）；Ｂ组３年累积再出血率１００％，显著高于同期Ａ组的９０％（Ｐ＜００５）。结论：根除Ｈｐ可提高十二指肠溃疡愈合率和减少溃疡复发率，尤可显著减少溃疡再出血率，提示根除Ｈｐ很可能改变出血性十二指肠溃疡的自然病程。     

内镜下注射结合静脉注射奥美拉唑对消化性溃疡活动性出血的疗效

目的观察内镜注射治疗联用不同剂量的奥美拉唑(OME)及单用OME对消化性溃疡活动性出血患者的疗效。方法采用随机对照的方法。把101例内镜下有活动性出血的消化性溃疡出血患者,随机分为3组,分别接受①内镜注射止血治疗联用每天2次静脉注射OME40mg,疗程5d;②内镜注射止血治疗联用每天1次静脉注射OME40mg,疗程5d;③单用每天2次静脉注射OME40mg,疗程5d。治疗期间观察患者的止血时间、输血量、再出血情况及住院时间。结果3组患者的再出血率为3/35(8.6％),9/32(28.1％),15/34(44.1％),差异有显著性(P＜0.05);手术率1/35(2.9％),2/32(6.3％),7/34(20.6％),差异有显著性(P＜0.05);死亡率0/34(0％),1/32(3.1％),1/34(2.9％),差异无显著性(P＞0.05);输血量(3.7±2.7)单位(每单位=200m1),(5±2.5)单位,(2.5±2.4)单位,差异无显著性(P＞0.05);止血时间分别为(1.8±1.5)d,(3.8±1.9)d,(5.5±2.1)d,差异有显著性(P＜0.05);住院时间(8.7±2.5)d,(15.7±6.9)d,(17.1±8.3)d,差异有显著性(P＜0.05)。结论内镜注射治疗联用每天2次静脉注射40mgOME疗效最好o     

含阿奇霉素的三联疗法对幽门螺杆菌阳性十二指肠球部溃疡的疗效

目的观察埃索美拉唑、阿莫西林、阿奇霉素治疗幽门螺杆菌（Hp）阳性十二指肠球部溃疡的疗效。方法治疗组1：埃索美拉唑20mgbid、阿莫西林1.0bid、阿奇霉素0.5qd（连续服用3d）,疗程1周;治疗组2：埃索美拉唑20mgbid、阿莫西林1.0bid、阿奇霉素0.5qd（连续服用3d）,疗程2周;对照组：埃索美拉唑20mgbid、阿莫西林1.0bid、克拉霉素0.25bid,疗程1周。4周后复查电子胃镜及13C尿素呼气试验。结果实验组1与实验组2比较,溃疡愈合率、Hp根除率、症状缓解率无显著性差异,但与对照组比较有显著性差异。结论埃索美拉唑、阿莫西林、阿奇霉素三联7d疗法治疗Hp阳性十二指肠球部溃疡可获得满意的临床疗效和Hp根除率。     

Gastric secretory investigation of recurrent ulcer after surgery for duodenal ulcer.

The results of gastric secretory studies in 192 cases of recurrent ulcer after surgery for duodenal ulcer were analyzed and compared with the secretory data collected in a control group of 74 duodenal ulcer patients who had undergone various forms of gastric surgery, but who did not develop a recurrent ulcer (controls). The patients studied comprised 46 cases of recurrent ulcer after partial gastrectomy, 10 cases of recurrent ulcer after partial gastrectomy and bilateral truncal vagotomy, 56 cases of recurrent ulcer after truncal vagotomy and drainage, 52 cases of recurrent ulcer after highly selective vagotomy, and finally 28 cases in which the recurrent ulcer led to the diagnosis of the Zollinger-Ellison syndrome. The entire study was based upon an analysis of the basal acid output, the response to maximal stimulation by pentagastrin or by histalog and by insulin in the case of previous vagotomy, and finally on an assessment of basal serum gastrin. The analysis has suggested minimal secretory levels with discriminative values useful for the postoperative diagnosis of recurrent ulcer and for an assessment of the completeness of vagotomy (ratio PAO Insulin/PAO pentagastrin or histalog). Moreover, an analysis of various elements of the sequential basal pentagastrin-insulin test permitted us to approach the pathophysiological mechanism responsible for ulcer recurrence, and to identify suitable criteria for selection of the best treatment.     

潘托拉唑治疗消化性溃疡临床疗效观察

目的：研究潘托拉唑治疗消化性溃疡的疗效及安全性。方法：将经胃镜证实的消化性溃疡患者随机分成潘托拉唑组（治疗组,简称潘组）和奥美拉唑组（对照组,简称奥组）,其中潘组60例,应用潘托拉唑40mg,1次／d;奥组58例;应用败类美拉唑20mg,1次／d。十二指肠溃疡患者疗程4周,胃溃疡6周。停药后均复查胃镜观察溃疡愈合情况。治疗期间每周随访1次。并记录症状改善情况及不良反应。结果：十二指肠溃疡的愈合率两组分别为91．7％和94．7％,胃溃疡的愈合率两组分别为91．7％反应。结果十二指肠溃疡的愈合率两组分别为91．7％和94．7％,胃溃疡的愈合率两组分别为91．7％和90．0％,P值均＞0．05。各项症状的改善情况两组相仿（P＞0．05）。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较高的治愈率和症状改善率。疗效与奥美拉唑相当,其不良反应很少,患者耐受性好,是一种有应用前景的质子泵抑制剂。