消化性溃疡的治疗进展及述评

Advances in the Treatment of Peptic Ulcer Disease

消化性溃疡的发生主要与胃十二指肠黏膜的损害因素和黏膜自身防御-修复因素之间失平衡有关。其中胃酸分泌异常、幽门螺杆菌(H.pylori)感染和非甾体抗炎药(NSAID)是引起消化性溃疡的最常见病因。质子泵抑制剂(PPI)是抑酸治疗的基础。新一类抑酸药物有钾离子竞争性酸阻滞剂(potassium-competitive acid blockers,P-CABs)。正在进行的初期临床试验证明其起效更快,抑酸作用持续时间更长。国际上近年来发布或更新了多个幽门螺杆菌相关指南或共识,推荐的一线治疗方案是以PPI为基础的三联治疗(PPI+阿莫西林+克拉霉素),疗程7d^14d。序贯疗法(sequential therapy)治疗幽门螺杆菌感染具有疗效高、耐受性和依从性好等优点,值得尝试。PPI是防治NSAID溃疡的首选药物。

The mechanism of peptic ulcer disease is due to the imbalance between invasive and defensive factors of gastroduodenai mucosa. Abnormal gastric acid secretion, Helicobacter pylori（ H. pylori）infection and use of non steroid anti--in-flammatory drugs （NSAIDs） are the most common causes of peptic ulcer disease. Proton pump inhibitors （PPI） are the basic drugs to inhibit gastric acid secretion. A new class of antiseeretory drugs, potassium--competitive acid blockers（P--CABs） ,possess potent and long--lasting effects, and is under way in its early stage of clinical trail. Several H. pylori in fection management guidelines have been published or renewed in recent years. PPI--based 7--14 days triple therapy was recommended as the first line therapy in the eradication of H. pylori infection. Sequential therapy is a worthwhile effort for the eradication of H. pylori infection. PPI is the first choice for the prevention and treatment of NSAID related ulcer.