Mahachai Varocha, Thomson Alan B R, Vilaichone Ratha-korn
Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Med Assoc Thai. 2004 Sep;87 Suppl 2:S295-9.
Peptic ulcer bleeding remains an important emergency situation with a high incidence and carries significant morbidity and mortality. Current evidence suggests that H. pylori and NSAIDs increase the risk of peptic ulcer bleeding and these two factors seem to act independently. Testing for, and cure of, H. pylori infection is recommended in patients prior to the initiation of NSAID therapy and in those who are currently receiving NSAIDs and have a history of peptic ulcer bleeding. For patients who present with peptic ulcer bleeding but require NSAIDs long-term, H. pylori eradication therapy should be considered, followed by continuous proton pump inhibitor prophylaxis to prevent re-bleeding, regardless of which kind of NSAID (nonselective NSAID/coxib) is being prescribed. The success of eradication should always be confirmed because of the risk of peptic ulcer recurrences and bleeding complication.
消化性溃疡出血仍然是一种重要的紧急情况，发病率高，且具有显著的发病率和死亡率。目前的证据表明，幽门螺杆菌和非甾体抗炎药会增加消化性溃疡出血的风险，这两个因素似乎独立起作用。建议在开始非甾体抗炎药治疗之前，以及在目前正在服用非甾体抗炎药且有消化性溃疡出血病史的患者中检测和治疗幽门螺杆菌感染。对于出现消化性溃疡出血但需要长期服用非甾体抗炎药的患者，无论正在开具哪种非甾体抗炎药（非选择性非甾体抗炎药/环氧化酶-2抑制剂），都应考虑根除幽门螺杆菌治疗，随后持续使用质子泵抑制剂进行预防以防止再次出血。由于存在消化性溃疡复发和出血并发症的风险，根除治疗的成功必须始终得到确认。
