内科学 消化性溃疡钟良.pptVIP

Treatment— acid secretion inhabitor Proton Pump Inhibitors PPI: Prilosec, Prevacid, Nexium, Protonix, or Aciphex for 4-8 weeks H2 receptor antagonists HRA: Tagament, Pepcid, Axid, or Zantac for up to 8 weeks 第二十九页，共四十一页，2022年，8月28日 内科学 消化性溃疡钟良 第一页，共四十一页，2022年，8月28日 Definition A circumscribed ulceration of the gastrointestinal mucosa occurring in areas exposed to acid and pepsin and most often caused by Helicobacter pylori infection. (Uphold Graham, 2003) 第二页，共四十一页，2022年，8月28日 Peptic ulcers:Gastric and Duodenal 第三页，共四十一页，2022年，8月28日 PUD Demographics Higher prevalence in developing countries H. Pylori is sometimes associated with socioeconomic status and poor hygiene In the US: Lifetime prevalence is ~10%. PUD affects ~4.5 million annually. Hospitalization rate is ~30 pts per 100,000 cases. Mortality rate has decreased dramatically in the past 20 years approximately 1 death per 100,000 cases 第四页，共四十一页，2022年，8月28日 Comparing Duodenal And Gastric Ulcers 第五页，共四十一页，2022年，8月28日 Epidemiology (DU) Duodenal sites are 4x as common as gastric sites Most common in middle age peak 30-50 years Male to female ratio—4:1 Genetic link: 3x more common in 1st degree relatives More common in patients with blood group O Associated with increased serum pepsinogen H. pylori infection common up to 95% Smoking is twice as common 第六页，共四十一页，2022年，8月28日 Gastric Ulcers Common in late middle age incidence increases with age Male to female ratio—2:1 More common in patients with blood group A Use of NSAIDs - associated with a three- to four-fold increase in risk of gastric ulcer Less related to H. pylori than duodenal ulcers – about 80% 10 - 20% of patients with a gastric ulcer have a concomitant duodenal ulcer 第七页，共四十一页，2022年，8月28日 Etiology A peptic ulcer is a mucosal break, 3 mm or greater, that can involve the stomach or duodenum. The most important contributing factors are H pylori, NSAIDs, acid, and pepsin. Additional aggressive factors include smoking, ethano