季国忠消化性溃疡治疗进展.ppt

,Departmentofgastroenterology,SecondAffiliatedHospitalofNanjingMedicalUniversity,JiGuozhong（季国忠）,SeveralProblemsRelativetoPepticUlcerDisease,南京医科大学第二附属医院,Definition,Introductionofpepticulcer(PU),Ulcersaredefectsinthegastrointestinalmucosathatpenetratemucosa,submucosaandthemuscularismucosa,GU,DU,南京医科大学第二附属医院,Epidemiology,Introductionofpepticulcer(PU),About510percentofallindividualsdevelopPuintheirlifetime.,48millionpeople,350,000newcaseseachyearintheU.S.,ButinChina?,DuismorecommonthanGu.,Introductionofpepticulcer(PU),Etiology(Causes),pH(hydrochloricacidandpepsin),Hp(Helicobacterpylori),NSAIDS,Smoking,tea,coffee,stress(emotion),南京医科大学第二附属医院,1910,SchwartzNoacidNoulcer,(nonsteroidalantiinflammatorydrugs),Itisthemostcommonchronicbacterialinfectioninhumans.Aboutone-halfoftheworldspopulationareinfectedwithHp.ItdisruptsaprotectivelayerofmucousanditsenzymesandtoxinscancausestomachandduodenumcellsinjurydevelopulcerormoreseriousproblemsCancer,南京医科大学第二附属医院,Introductionofpepticulcer(PU),Mechanisms,Thereisaneffectivebalancebetweenthedefensivefactorsandaggressive(damage)factors,Disruptionofthisbalanceleadstopepticulcer.,南京医科大学第二附属医院,Introductionofpepticulcer(PU),Mechanisms,Aggressivefactors,Defensivefactors,acid,pepsin,bile,pancreaticenzymes,Hp,etal,bicarbonate,mucus,mucosalbloodflow,cellrenewal,etal,南京医科大学第二附属医院,Introductionofpepticulcer(PU),Symptoms,Pain(70percent),Nausea(50percent),Vomiting(20percent),Weightloss(20percent),Bleeding(15percent),南京医科大学第二附属医院,Diagnosis,Introductionofpepticulcer(PU),basesonthehistoryandphysicalexaminationanddependsonradiographyorendoscopy,Endoscopyismoreaccurateandallowsdirectedbiopsy,cytologicstudyandHpdiagnosis.,南京医科大学第二附属医院,Treatmentstrategy,Nocomplications-medicaltherapy.,Twicedramaticevolutions,1970s-1980s：H2RA（Cimetidine）,PPI（Omeprazole）,1980s-2000s:HP,Inselectingadrugwithwhichtotreatapatientwithpu,fourfactorsmustbeconsidered:effectiveness,safety,convenience,cost.,A:PPI+twoantibioticsB:CBS+twoantibioticsC:H2RA+twoantibiotics,南京医科大学第二附属医院,Treatmentstrategy,H.pyloriinfectionpositive:eradicateHp,Antibiotics:,clarithromycinmetronidazoleAmoxycillintetracycline,PPI:,omeprazoleLansoprazolepantoprazolerabeprazoleesomeprazole,H2RA,CimetidineRanitidineFamotidinenizatidine,H.pyloriinfectionnegative,H2RAorPPIonly,南京医科大学第二附属医院,stepupandstepdowntherapy,Treatmentstrategy,beginsempiricallywithlowercostalternativessuchaslifestylemodifications,antacids,andH2AntagonistsreservingPPIsfortreatmentfailuresandpatientswithmoresevereformsofdisease,Step-Uptherapy,Step-Downtherapy,beginswithaPPIforseveralweeksandthentreatmentisstepped-downtoanH2Antagonist,AcidSuppressiveTherapyCostComparison,南京医科大学第二附属医院,Complications:(Bleeding,perforation,obstruction,malignant),Treatmentstrategy,Co