消化性溃疡出血的管理：一项荷兰全国性调查。

Management in peptic ulcer hemorrhage: a Dutch national inquiry.

作者信息

van Leerdam M E, Rauws E A, Geraedts A A, Tytgat G N

机构信息

Dept. of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.

出版信息

Endoscopy. 2000 Dec;32(12):935-42. doi: 10.1055/s-2000-9627.

DOI:10.1055/s-2000-9627

PMID:11147941

Abstract

BACKGROUND AND STUDY AIMS

There is no consensus as to what endoscopic hemostatic therapy and pharmacotherapy should be used in peptic ulcer hemorrhage (PUH). We conducted a mail survey to investigate current management of ulcer hemorrhage in the Netherlands.

METHODS

A questionnaire was sent to gastroenterologists or, if not present, to internists, performing endoscopies, in every hospital in the Netherlands (n = 123). Endoscopic hemostatic therapy, pharmacotherapy, endoscopic reintervention, and management of Helicobacter pylori were evaluated.

RESULTS

90/123 (73%) questionnaires were returned. Endoscopic hemostatic therapy is given in ulcers classified as Forrest Ia, Ib, IIa, IIb, and IIc by, respectively, 89%, 93%, 83%, 47%, and 19% of respondents. Gastroenterologists perform endoscopic therapy more often in Forrest Ib (P=0.03), IIa (P=0.002), and IIb (P=0.001) ulcers when compared with internists. Endoscopic injection therapy is used by 93% of respondents as first modality. Epinephrine combined with polidocanol is most commonly used (60%). Pharmacotherapy is given by 97%. A total of 71% use proton pump inhibitors (PPIs), and 26% use H2-receptor antagonists (H2RAs), both mainly initially given intravenously. In case of suspected rebleeding, endoscopic reintervention is performed by 76%, including a significantly greater percentage of gastroenterologists (89% of gastroenterologists vs. 60% of internists, P=0.005), whereas the others refer the patient directly for surgery. Almost all respondents investigate for H. pylori. Eradication is confirmed by only 64% (80% of gastroenterologists vs. 50% of internists, P=0.004).

CONCLUSIONS

There are important differences in management of peptic ulcer hemorrhage between gastroenterologists and internists in the Netherlands. Management is only partly in accordance with evidence-based medicine.

摘要

背景与研究目的

对于消化性溃疡出血（PUH）应采用何种内镜止血治疗和药物治疗，目前尚无共识。我们进行了一项邮件调查，以研究荷兰目前对溃疡出血的处理方法。

方法

向荷兰每家医院（共123家）中进行内镜检查的胃肠病学家发送问卷，若医院没有胃肠病学家，则发送给内科医生。对内镜止血治疗、药物治疗、内镜再次干预以及幽门螺杆菌的处理情况进行评估。

结果

共收回90/123份（73%）问卷。对于分别被归类为Forrest Ia、Ib、IIa、IIb和IIc级的溃疡，进行内镜止血治疗的受访者比例分别为89%、93%、83%、47%和19%。与内科医生相比，胃肠病学家在Forrest Ib（P = 0.03）、IIa（P = 0.002）和IIb（P = 0.001）级溃疡中更常进行内镜治疗。93%的受访者将内镜注射治疗作为首选方式。最常用的是肾上腺素联合聚多卡醇（60%）。97%的受访者采用药物治疗。共有71%的人使用质子泵抑制剂（PPI），26%的人使用H2受体拮抗剂（H2RA），两者主要最初通过静脉给药。在怀疑再次出血的情况下，76%的人会进行内镜再次干预，其中胃肠病学家的比例显著更高（胃肠病学家为89%，内科医生为60%，P = 0.005），而其他人则直接将患者转诊进行手术。几乎所有受访者都对幽门螺杆菌进行检测。仅64%的人确认幽门螺杆菌已根除（胃肠病学家为80%，内科医生为50%，P = 0.004）。