Infliximab is superior to other biological agents for treatment of active ulcerative colitis:A meta-analysis

AIM: To compare the efficacy and safety of biological agents for the treatment of active ulcerative colitis(UC).METHODS: PubMed, MEDLINE, EMBASE and the Cochrane library were searched to screen relevant articles from January 1996 to August 2014. The mixedtreatment comparison meta-analysis within a Bayesian framework was performed using WinBUGS14 software.The proportions of patients reaching clinical response,clinical remission and mucosal healing in induction and maintenance phases were analyzed as efficacy indicators. Serious adverse events in maintenance phase were analyzed as safety indicators.RESULTS: The meta-analysis results showed that biological agents achieved better clinical response,clinical remission and mucosal healing than placebo.Indirect comparison indicated that in induction phase,infliximab was more effective than adalimumab in inducing clinical response(OR = 0.41, 95%CI:0.29-0.57), clinical remission(OR = 0.33, 95%CI:0.19-0.56) and mucosal healing(OR = 0.33, 95%CI:0.19-0.56), and golimumab in inducing clinical response(OR = 0.66, 95%CI: 0.39-2.33) and mucosal healing(OR = 2.15, 95%CI: 1.18-4.22). No significant difference was found between placebo and biological agents regarding their safety.CONCLUSION: All biological agents were superior to placebo for UC treatment in both induction and maintenance phases with a similar safety profile, and infliximab had a better clinical effect than the other biological agents.

Gastrointestinal contrast-enhanced ultrasonography for diagnosis and treatment of peptic ulcer in children

BACKGROUND The detection rate of peptic ulcer in children is improving,with development of diagnostic procedures.Gastroscopy is the gold standard for the diagnosis of peptic ulcer,but it is an invasive procedure.Gastrointestinal contrast-enhanced ultrasonography(CEUS)has the advantages of being painless,noninvasive,nonradioactive,easy to use,and safe.AIM To investigate the clinical value of CEUS for diagnosis and treatment of peptic ulcer in children.METHODS We investigated 43 children with digestive tract symptoms in our hospital from January 2021 to June 2022.All children were examined by routine ultrasound,gastrointestinal CEUS,and gastroscopy.The pathological results of gastroscopy were taken as the gold standard.Routine ultrasonography was performed before gastrointestinal CEUS.Conventional ultrasound showed the thickness of the gastroduodenal wall,gastric peristalsis,and the adjacent organs and tissues around the abdominal cavity.Gastrointestinal CEUS recorded the thickness of the gastroduodenal wall;the size,location and shape of the ulcer;gastric peristalsis;and adjacent organs and tissues around the abdominal cavity.The results of routine ultrasound and gastrointestinal ultrasound were compared with those of gastroscopy to evaluate the diagnostic results and coincidence rate of routine ultrasound and gastrointestinal CEUS.All children received informed consent from their guardians for CEUS.This study was reviewed and approved by the hospital medical ethics committee.RESULTS Among the 43 children,17(15 male,2 female)were diagnosed with peptic ulcer by gastroscopy.There were 26 children with nonpeptic ulcer.There were eight cases of peptic ulcer and 35 of nonpeptic ulcer diagnosed by conventional ultrasound.The diagnostic coincidence rate of peptic ulcer in children diagnosed by conventional ultrasound was 79.1%(34/43),which was significantly different from that of gastroscopy(P=0.033).It indicates that the coincidence rate of gastrointestinal contrast-enhanced ultrasound and gastroscope is low.Fifteen cases of peptic ulcer and 28 of nonpeptic ulcer were diagnosed by CEUS.The diagnostic coincidence rate of peptic ulcer in children was 95.3%(41/43).There was no significant difference between CEUS and gastroscopy(P=0.655).It indicates that the coincidence rate of gastrointestinal contrast-enhanced ultrasound and gastroscope is high.CONCLUSION Gastrointestinal CEUS has a high coincidence rate in the diagnosis of peptic ulcer in children,and can be used as a preliminary examination method.

Changes of gastric ulcer bleeding in the metropolitan area of Japan

BACKGROUND The two main causes of gastric ulcer bleeding are Helicobacter pylori(H.pylori)infection and ulcerogenic medicines,although the number of cases caused by each may vary with age.In Japan,the rate of H.pylori infection has fallen over the last decade and the number of prescriptions for non-steroidal anti-inflammatory drugs(NSAIDs)and antithrombotic drugs is increasing as the population ages.Methods of treatment for gastric ulcer bleeding have advanced with the advent of hemostatic forceps and potassium-competitive acid blocker(P-CAB).Thus,causes and treatments for gastric ulcer bleeding have changed over the last decade.AIM To examine the trends of gastric ulcer bleeding over 10 years in the metropolitan area of Japan.METHODS This is a single-center retrospective study.A total of 564 patients were enrolled from inpatients admitted to our hospital with gastric ulcer bleeding between 2006 and 2016.Age,medication history,H.pylori infection,method of treatment,rate of rebleeding,and the length of hospitalization were analyzed.Factors associated with gastric ulcer bleeding were evaluated using Fisher’s exact test,Pearson’s Chi-squared test or Student’s t-test as appropriate.The Jonckheere-Terpstra test was used to evaluate trends.A per-protocol analysis was used to examine the rate of H.pylori infection.RESULTS There was a significant increase in the mean age over time(P<0.01).The rate of H.pylori infection tended to decrease over the study period(P=0.10),whereas the proportion of patients taking antithrombotic agents or NSAIDs tended to increase(P=0.07).Over time,the use of NSAIDs and antithrombotic drugs increased with age.By contrast,the rate of H.pylori infection during the study period fell with age.H.pylori-induced ulcers accounted for the majority of cases in younger patients(<70 years old);however,the rate decreased with age(P<0.01).The method of treatment trend has changed significantly over time.The main method of endoscopic hemostasis has changed from clipping and injection to forceps coagulation(P<0.01),and frequently prescribed medicines have changed from proton pump inhibitor to P-CAB(P<0.01).The rate of rebleeding during the latter half of the study was significantly lower than that in the first half.CONCLUSION These trends,gastric ulcers caused by ulcerogenic drugs were increasing with age and H.pylori-induced ulcers were more common in younger patients,were observed.

Current scenario of traditional medicines in management of diabetic foot ulcers:A review

Diabetic foot infections and diabetic foot ulcers(DFU)cause significant suffering and are often recurring.DFU have three important pathogenic factors,namely,microangiopathy causing local tissue anoxia,neuropathy making the foot prone to injuries from trivial trauma,and local tissue hyperglycaemia favouring infection and delaying the wound healing.DFU have been the leading cause for non-traumatic amputations of part or whole of the limb.Western medicines focus mainly on euglycaemia,antimicrobials,debridement and wound cover with grafts,and off-loading techniques.Advances in euglycaemic control,foot care and footwear,systemic antimicrobial therapy,and overall health care access and delivery,have resulted in an overall decrease in amputations.However,the process of wound care after adequate debridement remains a major cost burden globally,especially in developing nations.This process revolves around two basic concerns regarding control/eradication of local infection and promotion of faster healing in a chronic DFU without recurrence.Wound modulation with various dressings and techniques are often a costly affair.Some aspects of the topical therapy with modern/Western medicines are frequently not addressed.Cost of and compliance to these therapies are important as both the wounds and their treatment are“chronic.”Naturally occurring agents/medications from traditional medicine systems have been used frequently in different cultures and nations,though without adequate clinical base/relevance.Traditional Chinese medicine involves restoring yin-yang balance,regulating the‘chi’,and promoting local blood circulation.Traditional medicines from India have been emphasizing on‘naturally’available products to control wound infection and promote all the aspects of wound healing.There is one more group of chemicals which are not pharmaceutical agents but can create acidic milieu in the wound to satisfy the above-mentioned basic concerns.Various natural and plant derived products(e.g.,honey,aloe vera,oils,and calendula)and maggots are also used for wound healing purposes.We believe that patients with a chronic wound are so tired physically,emotionally,and financially that they usually accept native traditional medicine which has the same cultural base,belief,and faith.Many of these products have never been tested in accordance to“evidence-based medicine.”There are usually case reports and experience-based reports about these products.Recently,there have been some trials(in vitro and in vivo)to verify the claims of usage of traditional medicines in management of DFU.Such studies show that these natural products enhance the healing process by controlling infection,stimulating granulation tissue,antimicrobial action,promoting fibroblastic activity and collagen deposition,etc.In this review,we attempt to study and analyse the available literature on results of topical traditional medicines,which are usually advocated in the management of DFU.An integrated and‘holistic’approach of both modern and traditional medicine may be more acceptable to the patient,cost effective,and easy to administer and monitor.This may also nevertheless lead to further improvement in quality of life and decrease in the rates of amputations for DFU.

Colitis associated with biological agents

In the past,there has been considerable focus on a host of drugs and chemicals that may produce colonic toxicity.Now,a variety of new biological monoclonal antibody agents,usually administered by infusion,have appeared in the clinical realm over the last decade or so to treat different chronic inflammatory or malignant disorders.For some of these agents,adverse effects have been documented,including apparently new forms of immune-mediated inflammatory bowel disease.In some,only limited symptoms have been recorded,but in others,severe colitis with serious complications,such as bowel perforation has been recorded.In others,adverse effects may have a direct vascular or ischemic basis,while other intestinal effects may be related to a superimposed infection.Some new onset cases of ulcerative colitis or Crohn's disease may also be attributed to the same agents used to treat these diseases,or be responsible for disease exacerbation.Dramatic and well documented side effects have been observed with ipilimumab,a humanized monoclonal antibody developed to reduce and overcome cytotoxic T-lymphocyte antigen 4,a key negative feedback regulator of the T-cell anti-tumor response.This agent has frequently been used in the treatment of different malignancies,notably,malignant melanoma.Side effects with this agent occur in up to 40% and these are believed to be largely immune-mediated.One of these is a form of enterocolitis that may be severe,and occa-sionally,fatal.Other agents include rituximab(an antiCD20 monoclonal antibody),bevacizumab(a monoclonal antibody against the vascular endothelial growth factor) and anti-tumor necrosis factor agents,including infliximab,adalimumab and etanercept.

Herpes simplex induced necrotizing tonsillitis in an immunocompromised patient with ulcerative colitis

We here present the case of a 22-year-old female of Suriname ethnicity with ulcerative colitis who received treatment with mercaptopurine and infliximab.She presented herself with a severe necrotizing tonsillitis due to herpes simplex virus type-1(HSV-1).Combination therapy consisting of immunomodulators and anti-tumor necrosis factor(TNF) agents is increasingly being used.Anti-TNF therapy is associated with an increased risk of developing serious infections,and especially patients receiving combination treatment with thiopurines are at an increased risk.We here show that HSV infections can cause a severe tonsillitis in immunocompromised patients.Early recognition is essential when there is no improvement with initial antibiotic therapy within the first 24 to 72 h.HSV infections should be in the differential diagnosis of immunocompromised patients presenting with a necrotizing tonsillitis and can be confirmed by polymerase chain reaction.Early treatment with antiviral agents should be considered especially if antibiotic treatment fails in such patients.

CLINICAL STUDY ON 118 CASES OF ULCERATIVE COLITIS TREATED BY INTEGRATION OF TRADITIONAL CHINESE AND WESTERN MEDICINE

118 cases of ulcerative colitis were treated by integration of traditional Chinese and Western medicine. Another 86 cases of ulcerative colitis were treated by simple western drugs as controls. The therapeutic effects for both groups were observed and compared after two therapeutic courses of 40 consecutive days. As a result, 39 cases were cured, 60 cases improved and 19 cases failed, with a total effective rate of 84% in the treatment group; in the control group, 15 cases were cured, 37 cases improved and 34 cases failed, with a total effective rate of 60.5%. Statistically, the difference was very significant (P

Azithromycin in a triple therapy for H.pylori eradication in active duodenal ulcer

AIM:To assess and compare the efficacy and safety of two triple regimes:A)metronidazole,amoxicillin and omeprazole, which is still widely used in Russia,and B)azithromycin, amoxicillin and omeprazole in healing active duodenal ulcer and H.pylori eradication. METHODS:100 patients with active duodenal ulcer were included in the open,multicentre,randomized study with comparative groups.Patients were randomly assigned to one of the following one-week triple regimes:A) metronidazole 500 mg bid,amoxicillin I g bid and omeprazole 20 mg bid(OAM,n=50)and B)azithromycin 1 god for the first 3 days(total dose 3 g),amoxicillin 1 g bid and omeprazole 20 mg bid(OAA,n=50).Omeprazole 20 mg od was given after the eradication course as a monotherapy for three weeks.The control endoscopy was performed 8 weeks after the entry.H.pyloriinfection was determined in the entry of the study and four weeks after the cessation of treatment by means of histology and CLO-test. RESULTS:97 patients completed the study according to the protocol(1 patient of the OAM group did not come to the control endoscopy,2 patients of the OAA group stopped the treatment because of mild allergic urticaria).Duodenal ulcers were healed in 48 patients of the OAM group(96 %, C190.5-100 %)and in 46 patients of the OAA group(92 %, CI 89.5-94.5 %)(p=ns).H.pyloHinfection was eradicated in 15 out of 50 patients with OAM(30 %,CI 17-43 %)and in 36 out of 50 patients treated with OAA(72 %;CI 59-85 %) (P<0.001)-ITT analysis.CONCLUSION: The triple therapy with omeprazole, amoxicillin and metronidazole failed to eradicate H.pylori'vc\ the majority of patients, which is an essential argument to withdraw this regimen out of the national recommendations. Macrolide with amoxicillin are preferable to achieve higher eradication rates. Azithromycin (1 g od for the first 3 days) can be considered as a successful component of the triple PPI-based regimen.

Clinical Evidence to Prevent Pressure Ulcer at High Risk Patients: Systematic Review

Background: Pressure ulcer (PU) has clinical complications for patients, in addition to cost and quality related consequences for healthcare organizations. PU is defined as a pressure injury is localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other devices. The estimated prevalence of PUs among 918,621 patients declined from 13.5% in 2006 to 9.3% in 2015. Aim: The objective of this review is to evaluate the effectiveness of dressing and topical agent to prevent pressure ulcer, for hospitalized adults are at risk to develop a pressure ulcer. Methods: The review considered the randomized clinical trial (RCT), quasi pretest-posttest, and descriptive studies published in English. Participants in the studies were adult, aged over 18 years, considered to be a risk to develop PU, have no PU at the onset of the study, and managed at any healthcare setting. The primary outcome measured in the included studies was considered as the incidence of hospital acquired pressure ulcer (HAPU). Results: The review result out of five RCT and three non-RCT studies. Conclusion: The reviewed trials showed low certainty of imprecision. No definite preventive intervention to prevent PU among patients who at risk to develop PU. And the non-RCT studies, the findings indicate significant results of two studies, but due to the methodological context of non-RCT studies, the findings may not be granted to be generalized. The external factors at each study may affect the effectiveness of the intervention. Also, third study showed no significance of the intervention between groups.

Does the African garden egg offer protection against experimentally induced ulcers?

Objective:To evaluate the possible antiulcer effect of the African garden egg,Solanum aethiopicum(S.aethiopicum)(a domestic vegetable) experimentally in rats.Methods:A methanol extract of the plant fruit was prepared by maceration.Twenty five overnight fasted rats for each model were divided randomly into five groups of five rats.Groups 1,2,3,4 and 5 received normal saline,extract dose levels of 100,200 and 400 mg/kg and 100mg/kg of ranitidine respectively.All administrations were given orally.For the indomethacin and aspirin models, ulcerogenic agents(indomethacin,50 mg/kg and aspirin 200 mg/kg) were given thirty minutes after extract treatments and animals sacrificed 8 h later.The acidified ethanol model(ethanol 60%+0.1 mol/L HC1) was given 1hr after extract treatment and animals sacrificed 1 h later. Ulcer index was checked and analysed with appropriate statistical tools.Results:Extract of S. aethiopicum showed positive effect on all the models used.It produced higher ulcer inhibition than ranitidine in the indomethacin and acid-ethanol models.All the anti-ulcer effects of the extract at different doses were dose dependent but only in indomethacin model did it produce statistically significant(P【0.05) ulcer reduction in all doses compared to control.Conclusions: Garden egg,a readily cultivated crop vegetable possesses ulcer protective properties against ulcers induced experimentally making it a cheap source of natural anti-ulcer remedy.

Perforated duodenal ulcer secondary to deferasirox use in a child successfully managed with laparoscopic drainage:A case report

BACKGROUND A perforated gastroduodenal ulcer is rarely observed in children.Certain medications have been reported to cause ulcerations.Deferasirox,an iron chelating agent,has been previously reported to be associated with the development of gastroduodenal ulcers.CASE SUMMARY We report a case of a 3-year-old boy who was diagnosed with beta thalassemia major and treated with deferasirox.He presented to the emergency department with an acute abdomen.A perforated duodenal ulcer was suspected after X-ray imaging and laparoscopic exploration.It was successfully managed with laparoscopic washout and drainage.CONCLUSION Due to the rarity and severity of this case,it is a reminder that prevention and early recognition of gastrointestinal complications in patients receiving deferasirox are crucial.Minimally invasive laparoscopic surgery is both safe and feasible to treat perforated duodenal ulcers in selected patients.

大隐静脉高位结扎联合泡沫硬化剂注射术+外用重组人酸性成纤维细胞生长因子治疗重度静脉曲张合并溃疡患者的临床疗效

目的探讨大隐静脉高位结扎联合泡沫硬化剂注射术+外用重组人酸性成纤维细胞生长因子治疗重度静脉曲张合并溃疡患者的临床疗效。方法收集2018年1月至2023年6月解放军联勤保障部队第九〇〇医院收治的60例大隐静脉曲张患者的临床资料,按照治疗方式的不同将其分为对照组(n=30)与观察组(n=30),两组患者均采用大隐静脉高位结扎联合泡沫硬化剂注射术,对照组溃疡创面采用碘伏和生理盐水常规换药,观察组溃疡创面采用外用重组人酸性成纤维细胞生长因子治疗。比较两组患者手术时间、术中出血量、住院时间、住院费用、术后并发症的发生情况、治疗前后溃疡面积、溃疡愈合时间、疼痛数字评价量表(NRS)评分以及患者对诊疗过程的满意度。结果观察组患者住院时间短于对照组患者,差异有统计学意义(P﹤0.05)。术后第7天,两组患者溃疡面积均小于本组术前,且观察组患者溃疡面积小于对照组患者,差异均有统计学意义(P﹤0.05)。观察组患者溃疡愈合时间短于对照组患者,差异有统计学意义(P﹤0.05)。术后第14天,两组患者NRS评分均低于本组术前,且观察组患者NRS评分低于对照组患者,差异均有统计学意义(P﹤0.05)。观察组患者满意度评分高于对照组患者,差异有统计学意义(P﹤0.05)。结论大隐静脉高位结扎联合泡沫硬化剂注射术+外用重组人酸性成纤维细胞生长因子可显著促进下肢静脉性溃疡创面的愈合,明显缩短溃疡愈合时间、住院时间,缓解患者下肢疼痛程度,提高患者的诊疗满意度,值得在临床上进一步推广应用。

英夫利西单抗及维得利珠单抗治疗中重度溃疡性结肠炎的回顾性队列研究

目的比较英夫利西单抗(infliximab,IFX)及维得利珠单抗(vedolizumab,VDZ)在中重度溃疡性结肠炎(ulcerative Colitis,UC)治疗中的疗效及安全性差异。方法回顾性收集自2020年01月至2023年12月于昆明医科大学第一附属医院确诊为中重度UC并使用IFX/VDZ治疗的患者110例,其中IFX治疗组55例,VDZ治疗组55例。记录患者在治疗前(0周)及治疗14周、30周、54周的临床症状、疾病活动相关指标、内镜表现以及治疗过程中发生的不良反应,分析2种药物对于中重度UC治疗的疗效及安全性是否存在差异。结果2组患者在各项基线指标之间无显著差异(P>0.05);IFX治疗组的炎症指标(WBC、PLT、ESR、CRP)水平在第14周高于VDZ治疗组,营养指标ALB水平在第30周低于VDZ治疗组,其差异具有统计学意义(P<0.05);其余实验室指标在各随访节点之间的差异无统计学意义(P>0.05)。IFX治疗组及VDZ治疗组的临床应答率在治疗第14周(81.8%vs 85.5%)、第30周(80.8%vs 92.5%)及第54周(91.3%vs 90.0%)无显著差异(P>0.05);临床缓解率在治疗第14周(41.8%vs 49.1%)、第30周(50.0%vs 67.5%)及第54周(65.2%vs 63.3%)无显著差异(P>0.05);内镜应答率在治疗第14周(54.3%vs 72.2%)、第30周(41.2%vs 73.3%)及第54周(60.0%vs 75.0%)无显著差异(P>0.05);内镜缓解率在治疗第14周(34.3%vs 55.6%)及第54周(53.3%vs 54.2%)无显著差异(P>0.05),IFX治疗组的内镜缓解率在治疗第30周(23.5%vs 73.3%)低于VDZ治疗组,其差异具有统计学意义(P=0.005)。IFX治疗组与VDZ治疗组的失应答率在治疗14周至30周期间(7.3%vs 1.8%)无显著差异(P>0.05),IFX治疗组的失应答率在治疗第30周至54周期间(16.4%vs 0)高于VDZ治疗组,其差异具有统计学意义(P=0.005);IFX治疗组及VDZ治疗组不良反应发生率(10.9%vs 5.5%)之间差异无统计学意义(P>0.05)。结论在中重度UC的治疗中,IFX治疗组与VDZ治疗组在第14周、54周的临床应答率及临床缓解率、内镜应答率、内镜缓解率之间未观察到显著差异,在第30周IFX治疗组的内镜缓解率低于VDZ治疗组;维持治疗过程中IFX治疗组的失应答率高于VDZ治疗组,提示IFX治疗组可能存在更高的远期耐药率;两药物治疗过程中的不良反应发生率之间无显著差异。

溃疡性结肠炎生物制剂的研究现状和热点分析

目的 分析溃疡性结肠炎(UC)生物制剂的研究现状、热点和发展趋势,为我国UC生物制剂的相关研究提供参考。方法 检索Web of Science核心合集数据库中发表于2013年1月1日至2022年12月31日关于UC生物制剂研究的相关文献,利用文献计量在线分析平台(https://bibliometric.com/)和CiteSpace软件统计分析相关研究的发文量、国家/地区、机构、作者、期刊等文献关键特征。结果 共纳入文献3 928篇,年发文量整体呈逐年增加的趋势;开展该领域研究的国家/地区有109个,美国占领先优势(1 209篇,占总发文量的31.03%),且与其他国家合作密切;参与该领域研究的机构共456个,加州大学圣地亚哥分校的发文量(121篇)和中心度(0.09)均排名首位;发文量最大的作者是法国洛林大学的Peyrin-Biroulet L(101篇),共被引频次排名首位的作者是加州大学圣地亚哥分校的Sandborn W J(1 055次);共计1 012个期刊发表了相关文献,发文量和共被引频次最高的期刊均为Inflammatory Bowel Diseases(267篇,1 376次);共被引频次最高的文献是Ungaro等在2017年发表的综述“Ulcerative colitis”,共被引文献中心度排名首位的是Sandborn等在2017年发表的“Tofacitinib as induction and maintenance therapy for ulcerative colitis”;该领域的研究热点主要集中在生物制剂有效性、治疗药物监测、特殊群体用药、药物经济学评价等方面。结论 我国UC生物制剂的研究与国外相比还存在一定差距,应加强国际合作交流,及时跟进该领域的研究热点和未来发展趋势。

生物制剂和小分子药物治疗溃疡性结肠炎有效性与安全性的网状Meta分析

背景溃疡性结肠炎(UC)是一种慢性复发和缓解性免疫介导的炎症性肠病,其治疗方式还存在争议,大约一半的患者病程发展复杂,伴有慢性活动或频繁复发的UC症状,严重影响了患者的生活质量。目的目前UC的治疗方式越来越多,本研究旨在比较生物制剂和小分子药物治疗UC患者的相对疗效和安全性。方法2名研究人员独立使用PubMed、Embase、Web of Science、Cochrane Library、中国知网、万方数据知识服务平台、维普网数据库搜索有关生物制剂和小分子药物治疗UC的随机对照试验,干预组为生物制剂或小分子药物,对照组为安慰剂。采用Cochrane偏倚风险工具、RevMan 5.4对纳入研究进行质量评价,采用R Studio进行成对分析和网络荟萃分析,采用累积排序概率图下面积(SUCRA)对各结局指标的纳入药物进行排序,以比较不同治疗方式对UC的临床疗效。结果共纳入25项研究,包括9546例UC患者,10种药物干预方案(Filgotinib 100 mg、Filgotinib 200 mg、Upadacitinib、Tofacitinib、Etrolizumab、Adalimumab、Vedolizumab、Golimumab 50 mg、Golimumab 100 mg、Infliximab)。各药物对临床缓解效果的SUCRA概率排序结果显示,Upadacitinib(94.1%)>Vedolizumab(85.1%)>Tofacitinib(74.3%)>Infliximab(72.7%)>Filgotinib 200 mg(51.5%)>Golimumab 100 mg(44.3%)>Golimumab 50 mg(39.3%)>Etrolizumab(38.9%)>Adalimumab(29.8%)>Filgotinib 100 mg(18.7%)>Placebo(0.7%)。各药物对临床反应效果的SUCRA概率排序结果显示,Upadacitinib(98.4%)>Infliximab(84.4%)>Tofacitinib(67.2%)>Vedolizumab(58.4%)>Golimumab50 mg(53.3%)>Adalimumab(34.6%)>Golimumab 100 mg(30.1%)>Placebo(0.4%)。各药物对内镜缓解效果的SUCRA概率排序结果显示,Upadacitinib(98.7%)>Tofacitinib(68.6%)>Filgotinib 200 mg(59.6%)>Adalimumab(55.2%)>Etrolizumab(46.0%)>Vedolizumab(45.9%)>Filgotinib 100 mg(23.4%)>Placebo(2.2%)。各药物对黏膜愈合效果的SUCRA概率排序结果显示,Upadacitinib(99.7%)>Tofacitinib(77.2%)>Infliximab(65.2%)>Golimumab 50 mg(46.4%)>Vedolizumab(44.4%)>Adalimumab(33.8%)>Golimumab 100 mg(31.9%)>Placebo(1.0%)。各药物不良事件风险的SUCRA概率排序结果显示,Golimumab 100 mg(96.7%)>Golimumab 50 mg(92.1%)>Placebo(68.7%)>Tofacitinib(60.8%)>Adalimumab(60.7%)>Etrolizumab(47.2%)>Upadacitinib(42.2%)>Vedolizumab(41.3%)>Infliximab(27.0%)>Filgotinib 200 mg(6.6%)>Filgotinib 100 mg(6.2%)。结论Upadacitinib在临床反应、临床缓解、黏膜愈合以及内镜缓解方面均展现出最佳效用,在不良事件方面Filgotinib 100 mg表现出更为安全的结果。

幽门螺杆菌感染与非甾体抗炎药对消化性溃疡发病的影响

目的探讨幽门螺杆菌(Hp)感染与服用非甾体抗炎药(NSAIDs)在消化性溃疡发病中的作用。方法将该院消化内科2010年1月至2011年6月就诊的消化性溃疡患者76例作为研究组,同期就诊消化内科的非消化性溃疡患者117例作为对照组,应用单因素分析及多因素分析的方法计算两种暴露因素对消化性溃疡的比数比并估计相对危险度和95%可信区间(95%CI)。结果 Hp感染者患胃溃疡(GU)的危险性增加2.308倍,患十二指肠溃疡(DU)的危险性增加8.186倍;服用NSAIDs者患GU的危险性增加6.072倍,患DU的危险性增加2.823倍;Hp感染同时服用NSAIDs者患GU的危险性增加14.972倍,患DU的危险性增加28.873倍。结论 Hp感染和同时服用NSAIDs者可增加消化性溃疡发病的危险性,二者在消化性溃疡的发病中可协同作用增加消化性溃疡发病的危险性。

107例住院患者抗消化性溃疡药物利用分析

目的:了解南京军区福州总医院住院患者抗消化性溃疡药物利用情况。方法:回顾性调查本院消化内科2005年8月-2006年4月诊断为消化性溃疡的107例出院患者的病历,对用药频数、用药金额和药物不良反应等相关内容进行统计分析。结果:质子泵抑制剂的用药频数和用药金额在住院患者抗消化性溃疡药物应用中居首位。抗消化性溃疡药物费用占总药费的25．88％,占住院总费用的17．26％。8例患者的医嘱存在不合理用药情况,2例患者发生药物不良反应。结论:本院抗消化性溃疡药物应用基本合理,但该类药物的合理使用仍需进一步规范。

102例住院患者抗消化性溃疡药物使用分析

目的促进抗消化性溃疡药物的合理使用。方法采用回顾性调查方法,抽取中国人民解放军总医院2008年1月至8月102例消化性溃疡住院患者的病历资料,对用药情况、治疗天数、药物不良反应及预后等相关问题进行统计分析。结果使用频数居首位的抗消化性溃疡药物是质子泵抑制剂;用药监测仅发现5例存在不合理用药情况。结论该院抗消化性溃疡药物的使用基本合理,但仍有待进一步的规范。

上海市13家医院门急诊抗消化性溃疡药物处方分析

上海13家医院调查了1995年5月8日至1995年5月14日1周中门急诊抗消化性溃疡药物处方情况。抗消化性溃疡药物处方数约占门诊处方的1．3％～8．5％，急诊处方的0．4％～9．5％；处方多少顺序依次为：泰胃美、国产雷尼替丁片、洛赛克胶囊、德诺片、硫糖铝片等；金额多少顺序依次为：洛赛克胶囊、泰胃美、德诺片、国产奥美拉唑胶囊、洛赛克注射剂等。各家医院在处方习惯上各有特点。

难治性和复发性消化性溃疡的处理

难治性或复发性消化性溃疡的治疗对临床医师而言是一种挑战,使其得到最佳处理的重要条件是明确引起难治性或复发性消化性溃疡的潜在因素。幽门螺杆菌感染的识别和根除以及抑酸治疗能使溃疡愈合,并预防溃疡的复发。本文对消化性溃疡病难治或复发的原因和处理策略进行详细讨论。