季国忠消化性溃疡治疗进展1课件

Departmentofgastroenterology,SecondAffiliatedHospitalofNanjingMedicalUniversityJiGuozhong（）SeveralProblemsRelativetoPepticUlcerDisease南京医科大学第二附属医院Definition

Introductionofpepticulcer(PU)Ulcersaredefectsinthegastrointestinalmucosathatpenetratemucosa,submucosaandthemuscularismucosa

GUDU南京医科大学第二附属医院EpidemiologyIntroductionofpepticulcer(PU)About5~10percentofallindividualsdevelopPuintheirlifetime.

4~8millionpeople350,000newcaseseachyearintheU.S.

ButinChina?

DuismorecommonthanGu.DefensivefactorsAggressivefactors南京医科大学第二附属医院Introductionofpepticulcer(PU)AggressivefactorsDefensivefactorsMechanisms

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)SymptomsPain(70percent)Nausea(50percent)Vomiting(20percent)Weightloss(20percent)Bleeding(15percent)南京医科大学第二附属医院TreatmentstrategyNocomplications--medicaltherapy.Twicedramaticevolutions1970s-1980s：H2RA（Cimetidine）PPI（Omeprazole）1980s-2000s:HPInselectingadrugwithwhichtotreatapatientwithpu,fourfactorsmustbeconsidered:effectiveness,safety,convenience,cost.A:PPI+twoantibioticsB:CBS+twoantibioticsC:H2RA+twoantibiotics南京医科大学第二附属医院TreatmentstrategyH.pyloriinfectionpositive:eradicateHpAntibiotics:clarithromycinmetronidazoleAmoxycillintetracyclinePPI:

omeprazoleLansoprazolepantoprazolerabeprazoleesomeprazole

H2RA

CimetidineRanitidineFamotidinenizatidine

H.pyloriinfectionnegative

H2RAorPPIonly

南京医科大学第二附属医院stepupandstepdowntherapyTreatmentstrategybeginsempiricallywithlowercostalternativessuchaslifestylemodifications,antacids,andH2AntagonistsreservingPPIsfortreatmentfailuresandpatientswithmoresevereformsofdisease

Step-UptherapyStep-Downtherapy

beginswithaPPIforseveralweeksandthentreatmentis"stepped-down"toanH2Antagonist

南京医科大学第二附属医院Complications:(Bleeding,perforation,obstruction,malignant)TreatmentstrategyConservativemeasures(partly)