Martínek Jan, Hlavova Kristyna, Zavada Filip, Seifert Bohumil, Rejchrt Stanislav, Urban Ondrej, Zavoral Miroslav
Department of Internal Medicine of the First Medical Faculty and Central Military Hospital, Charles University, Prague, Czech Republic.
Scand J Gastroenterol. 2010 Oct;45(10):1156-61. doi: 10.3109/00365521.2010.497935.
Evidence does not support an association between systemic corticosteroid use and the development of peptic ulcer disease (PUD) and prophylactic anti-ulcer therapy is not routinely indicated. The aim was to find out the opinion of physicians in the Czech Republic on corticosteroid-induced ulcers.
A questionnaire-based study targeting 360 physicians of different specialties (100 from Gastroenterology, 100 from General Practice, 80 from Pneumology/Immunology, and 80 from Neurology/Neurosurgery).
Eighty-two percent of the physicians considered corticosteroids ulcerogenic, 7.5% of the responders considered them ulcerogenic only in patients with a family history of PUD, and 10.3% of the physicians considered corticosteroids non-ulcerogenic. Seventy-five percent of the responders would administer concomitant antisecretory treatment. Sixty-seven percent of the physicians thought that PUD was a frequent complication of corticosteroid therapy. If the ulcerogenic potential of ibuprofen, diclofenac, and prednisone was a subject of the physicians' judgment, a majority (40.5%) considered prednisone to be the most ulcerogenic substance. Thirty percent of gastroenterologists (vs. 1.9% of others; p < 0.001) did not consider corticosteroids to be ulcerogenic; 27.4% (vs. 4.3%; p < 0.01) would not administer an antisecretory prophylaxis routinely.
Although there is no evidence showing an association between PUD and the use of corticosteroids, a majority of physicians consider corticosteroids gastrotoxic. This applies, to a lesser extent, to gastroenterologists. Action should be taken to explode the myth about the gastrotoxicity of corticosteroids and to minimize useless expenses on concomitant prophylaxis.
证据并不支持全身使用糖皮质激素与消化性溃疡疾病（PUD）的发生之间存在关联，且通常不建议进行预防性抗溃疡治疗。本研究旨在了解捷克共和国医生对糖皮质激素诱发溃疡的看法。
一项基于问卷调查的研究，目标对象为360名不同专业的医生（100名来自胃肠病学专业，100名来自全科医学专业，80名来自肺病学/免疫学专业，80名来自神经病学/神经外科学专业）。
82%的医生认为糖皮质激素具有致溃疡作用，7.5%的应答者认为仅在有PUD家族史的患者中糖皮质激素才具有致溃疡作用，10.3%的医生认为糖皮质激素不具有致溃疡作用。75%的应答者会给予联合抗分泌治疗。67%的医生认为PUD是糖皮质激素治疗的常见并发症。如果将布洛芬、双氯芬酸和泼尼松的致溃疡潜力作为医生判断的对象，大多数（40.5%）认为泼尼松是最具致溃疡作用的物质。30%的胃肠病学家（相比之下，其他专业为1.9%；p<0.001）不认为糖皮质激素具有致溃疡作用；27.4%（相比之下，其他专业为4.3%；p<0.01）不会常规给予抗分泌预防措施。
尽管没有证据表明PUD与糖皮质激素的使用之间存在关联，但大多数医生认为糖皮质激素具有胃毒性。胃肠病学家的认同程度相对较低。应采取行动打破关于糖皮质激素胃毒性的误解，并尽量减少预防性联合用药的不必要费用。
