幽门螺杆菌阴性消化性溃疡

Helicobacter pylori-Negative Peptic Ulcer

根据是否服用非甾体抗炎药(NSAIDs)可将幽门螺杆菌(H.pylori)阴性消化性溃疡(PU)分为NSAIDs相关PU和非H.pylori、非NSAIDs相关PU。NSAIDs相关PU病程较短,常无典型的腹痛,近50%为无痛性,症状与实际病变相关性差,内镜下常表现为多发溃疡,溃疡直径较小,多集中于胃窦部。对NSAIDs相关PU的治疗仍有争议,对高危人群和非高危人群应采用不同的治疗策略。非H.pylori、非NSAIDs相关PU发生的机制复杂,可能与高胃酸分泌、基础疾病致黏膜防御机制受损、少见病原体感染、某些药物以及其他因素如吸烟、心理因素、应激、饮食习惯等有关。由于发病因素较多且无法明确,非H.pylori、非NSAIDs相关PU的治疗效果常较差。

Helicobacter pylori （H. pylori）-negative peptic ulcer （PU） can be divided into non-steroidal anti- inflammatory drugs （NSAIDs） related PU and non-H, pylori non-NSAIDs related PU. Patients with NSAIDs related PU more likely have a short history and atypical symptoms, about 50% of them are even asymptomatic. The correlation between symptoms and actual lesion is poor. Multiple small ulcers focused at gastric antrum are frequently seen at endoscopy. The treatment of NSAIDs related PU is still controversial. Specific treatment strategy should be applied to patients with high and low risk factors. The pathogenic mechanism of non-H, pylori non-NSAIDs related PU is complicated, many potential factors may contribute to the pathogenesis, such as high acid secretion, lowering of mucosal defense mechanism by underlying disease, infection of uncommon pathogens, some medications, and other factors such as smoking, psychic factors, stress, dietary habit, etc. Because of the multiple and complicated etiologic factors, the efficacy of treatment of non-H, pylori non-NASIDs related PU is frequently poor.