季国忠消化性溃疡治疗进展.pptx

Department of gastroenterology,Second Affiliated Hospital of Nanjing Medical UniversityJi Guozhong（季国忠季国忠）Several Problems Relative to Peptic Ulcer Disease 南京医科大学第二附属医院南京医科大学第二附属医院Definition Introduction of peptic ulcer(PU)Ulcers are defects in the gastrointestinal mucosa that penetrate mucosa,submucosa and the muscularis mucosa GUDU南京医科大学第二附属医院南京医科大学第二附属医院Epidemiology Introduction of peptic ulcer(PU)vAbout 510 percent of all individuals develop Pu in their lifetime.v 48 million peoplev 350,000 new cases each year in the U.S.v But in China?v Du is more common than Gu.Introduction of peptic ulcer(PU)Etiology(Causes)vpH(hydrochloric acid and pepsin)vHp(Helicobacter pylori)vNSAIDS vSmoking,tea,coffee,stress(emotion)南京医科大学第二附属医院南京医科大学第二附属医院1910,Schwartz No acid No ulcer 1983 Marshall、WarrenNo acid No Hp No ulcer(nonsteroidal antiinflammatory drugs)It is the most common chronic bacterial infection in humans.About one-half of the worlds population are infected with Hp.It disrupts a protective layer of mucous and its enzymes and toxins can cause stomach and duodenum cells injury develop ulcer or more serious problemsCancer Defensive factorsAggressive factors南京医科大学第二附属医院南京医科大学第二附属医院Introduction of peptic ulcer(PU)Aggressive factorsDefensive factorsMechanisms There is an effective balance between the defensive factors and aggressive(damage)factors,Disruption of this balance leads to peptic ulcer.南京医科大学第二附属医院南京医科大学第二附属医院Introduction of peptic ulcer(PU)Mechanisms vAggressive factors vDefensive factors acid,pepsin,bile,pancreatic enzymes,Hp,et al bicarbonate,mucus,mucosal blood flow,cell renewal,et al 南京医科大学第二附属医院南京医科大学第二附属医院Introduction of peptic ulcer(PU)Symptomsv Pain (70 percent)v Nausea (50 percent)v Vomiting (20 percent)v Weight loss (20 percent)v Bleeding (15 percent)南京医科大学第二附属医院南京医科大学第二附属医院Diagnosis Introduction of peptic ulcer(PU)v bases on the history and physical examination and depends on radiography or endoscopyv Endoscopy is more accurate and allows directed biopsy,cytologic study and Hp diagnosis.南京医科大学第二附属医院南京医科大学第二附属医院Treatment strategy*No complications-medical therapy.Twice dramatic evolutions1970s-1980s：H2RA（Cimetidine）PPI （Omeprazole）1980s-2000s:HPIn selecting a drug with which to treat a patient with pu,four factors must be considered:effectiveness,safety,convenience,cost.A:PPI+two antibioticsB:CBS+two antibioticsC:H2RA+two antibiotics南京医科大学第二附属医院南京医科大学第二附属医院Treatment strategy v H.pylori infection positive:eradicate HpAntibiotics:clarithromycin metronidazoleAmoxycillin tetracycline PPI:omeprazoleLansoprazolepantoprazole rabeprazoleesomeprazole H2RA Cimetidine Ranitidine Famotidine nizatidine v H.pylori infection negative H2RA or PPI only 南京医科大学第二附属医院南京医科大学第二附属医院v step up and step down therapyTreatment strategy begins empirically with lower cost alternatives such as lifestyle modifications,antacids,and H2 Antagonists reserving PPIs for treatment failures and patients with more severe forms of disease Step-Up therapy Step-Down therapy begins with a PPI for several weeks and then treatment is stepped-down to an H2 Antagonist DRUG DRUG AVE DOSE AVE DOSE$COST/30 d*$COST/30 d*CimetidineCimetidine400mg BID 400mg BID 1111RanitidineRanitidine150mg BID 150mg BID 2121pantoprazolepantoprazole40mg QD 40mg QD 8080FamotidineFamotidine20mg BID 20mg BID 9393rabeprazolerabeprazole20mg QD 20mg QD 101101esomeprazoleesomeprazole40 mg QD 40 mg QD 107107lansoprazolelansoprazole30mg QD 30mg QD 104104omeprazoleomeprazole20mg QD20mg QD111111Acid Suppressive Therapy Cost Comparison南京医科大学第二附属医院南京医科大学第二附属医院*Complications:(Bleeding,perforation,obstruction,malignant)Treatment strategy vConservative measures(partly)v Surgery Operation Bleeding,cannt be controlled perforation pyloric obstruction carcinomatous change南京医科大学第二附属医院南京医科大学第二附属医院Thanks!