季国忠（消化性溃疡治疗进展）1

nullnullDepartment of gastroenterology, Second Affiliated Hospital of Nanjing Medical UniversityJi Guozhong（季国忠） Several Problems Relative to Peptic Ulcer Disease null南京医科大学第二附属医院Definition Introduction of peptic ulcer (PU) Ulcers are defects in the gastrointestinal mucosa that penetrate mucosa, submucosa and the muscularis mucosa GUDUnull南京医科大学第二附属医院Epidemiology Introduction of peptic ulcer (PU) About 5~10 percent of all individuals develop Pu in their lifetime. 4~8 million people 350, 000 new cases each year in the U.S. But in China? Du is more common than Gu. nullIntroduction of peptic ulcer (PU) Etiology(Causes) pH (hydrochloric acid and pepsin) Hp (Helicobacter pylori) NSAIDS Smoking , tea , coffee, stress (emotion) 南京医科大学第二附属医院1910, Schwartz No acid No ulcer (nonsteroidal anti—inflammatory drugs) It is the most common chronic bacterial infection in humans. About one-half of the world’s population are infected with Hp. It disrupts a protective layer of mucous and its enzymes and toxins can cause stomach and duodenum cells injury → develop ulcer or more serious problems—Cancer null南京医科大学第二附属医院Introduction of peptic ulcer (PU) Mechanisms There is an effective balance between the defensive factors and aggressive(damage) factors, Disruption of this balance leads to peptic ulcer. null南京医科大学第二附属医院Introduction of peptic ulcer (PU) Mechanisms Aggressive factors Defensive factors acid, pepsin, bile, pancreatic enzymes, Hp,et al bicarbonate, mucus, mucosal blood flow, cell renewal,et al null南京医科大学第二附属医院Introduction of peptic ulcer (PU) Symptoms Pain ( 70 percent ) Nausea ( 50 percent ) Vomiting ( 20 percent ) Weight loss ( 20 percent ) Bleeding ( 15 percent )null南京医科大学第二附属医院Diagnosis Introduction of peptic ulcer (PU) bases on the history and physical examination and depends on radiography or endoscopy Endoscopy is more accurate and allows directed biopsy, cytologic study and Hp diagnosis. null南京医科大学第二附属医院Treatment strategy No complications --medical therapy.Twice dramatic evolutions1970s-1980s： H2RA （ Cimetidine ）PPI （ Omeprazole）1980s-2000s : HP In selecting a drug with which to treat a patient with pu, four factors must be considered: effectiveness, safety, convenience, cost. nullA: PPI+ two antibiotics B: CBS+ two antibiotics C: H2RA+ two antibiotics 南京医科大学第二附属医院Treatment strategy H. pylori infection positive: eradicate HpAntibiotics:clarithromycin metronidazole Amoxycillin tetracycline PPI: omeprazole Lansoprazole pantoprazole rabeprazole esomeprazole H2RA Cimetidine Ranitidine Famotidine nizatidine H. pylori infection negative H2RA or PPI only null南京医科大学第二附属医院 step up and step down therapyTreatment strategy begins empirically with lower cost alternatives such as lifestyle modifications, antacids, and H2 Antagonists reserving PPIs for treatment failures and patients with more severe forms of disease Step-Up therapy Step-Down therapy begins with a PPI for several weeks and then treatment is "stepped-down" to an H2 Antagonist nullAcid Suppressive Therapy Cost Comparison null南京医科大学第二附属医院Complications: (Bleeding, perforation, obstruction, malignant) Treatment strategy Conservative measures(partly) Surgery Operation Bleeding, cann’t be controlled perforation pyloric obstruction carcinomatous changenull南京医科大学第二附属医院Thanks!