Hayashi Takuya, Ohrui Nobuhiro, Kobayashi Masahiko, Ohashi Koichiro, Ikeda Tomosumi
Division of Environmental Medicine, National Defense Medical College Research Institute, Tokorozawa, Saitama, Japan.
Aviat Space Environ Med. 2003 Oct;74(10):1067-71.
The treatment of peptic ulcer disease has undergone profound changes due to the recognition of Helicobacter pylori as a causative factor. A survey of medical records was made to determine the prevalence of peptic ulcer among pilots of the Japan Air Self Defense Force (JASDF) and to decide on a possible change in JASDF medical policy toward an ulcer-treatment regime involving therapy to eradicate Helicobacter pylori.
The subjects were 955 male pilots, age 40 or older. Between 1996 and 1999, they underwent gastrointestinal endoscopy 2.47 times on average. Annual ulcer rates and recurrence rates were obtained from the endoscopic file data. Smoking habits and use of NSAIDs were also assessed as important risk factors for peptic ulcer.
The detection rate of open ulcer for each year was 2.3-3.1% in the stomach and 1.9-4.4% in the duodenum. For ulcers including scarring, the corresponding figures were 7.3-9.5% and 12.7-19.9%. The recurrence rate from S1 scars in the duodenum was 34%, significantly higher than that from S2 scars (7%) (p < 0.0005). There was no significant difference in recurrence rate between S1 scars and S2 scars in the stomach. There was a significant association between gastric ulcer and smoking (p < 0.0005). None of the pilots took long-term NSAID medications.
Peptic ulcer occurs more frequently in the JASDF pilots than in the general population. S1 scarring in the duodenum, as well as open ulcers in either stomach or duodenum, are candidates for Helicobacter pylori eradication therapy if the bacterium is detected. Other types of scars are also candidates for this therapy when pilots have symptoms related to infection with Helicobacter pylori.
由于认识到幽门螺杆菌是致病因素，消化性溃疡疾病的治疗发生了深刻变化。对日本航空自卫队（JASDF）飞行员的病历进行了调查，以确定消化性溃疡的患病率，并决定JASDF医疗政策是否可能改变为采用根除幽门螺杆菌的溃疡治疗方案。
研究对象为955名40岁及以上的男性飞行员。在1996年至1999年期间，他们平均接受了2.47次胃肠内窥镜检查。从内窥镜检查档案数据中获取年度溃疡发生率和复发率。吸烟习惯和非甾体抗炎药的使用也被评估为消化性溃疡的重要危险因素。
每年胃开放性溃疡的检出率为2.3%-3.1%，十二指肠为1.9%-4.4%。对于包括瘢痕形成的溃疡，相应数字分别为7.3%-9.5%和12.7%-19.9%。十二指肠S1瘢痕的复发率为34%，显著高于S2瘢痕（7%）（p<0.0005）。胃S1瘢痕和S2瘢痕的复发率之间无显著差异。胃溃疡与吸烟之间存在显著关联（p<0.0005）。没有飞行员长期服用非甾体抗炎药。
日本航空自卫队飞行员中消化性溃疡的发生率高于普通人群。如果检测到幽门螺杆菌，十二指肠的S1瘢痕以及胃或十二指肠的开放性溃疡都适合进行根除幽门螺杆菌治疗。当飞行员出现与幽门螺杆菌感染相关的症状时，其他类型的瘢痕也适合进行这种治疗。
