de Jongh Egbert, Numans Mattijs E, de Wit Niek J, Heemstra-Borst Corien G, Geijer Roeland M M, Burgers Jako S
Nederlands Huisartsen Genootschap, Utrecht.
Ned Tijdschr Geneeskd. 2013;157(22):A6101.
The guideline 'Gastric symptoms' covers the diagnosis and management of adults with dyspepsia in general practice, the prevention of unnecessary proton pump inhibitor use, and gastric protection during treatment with non-steroidal anti-inflammatory drugs (NSAIDs), including low-dose acetylsalicylic acid derivatives. During an initial episode of dyspepsia no distinction is made between reflux and ulcus symptoms because management is the same: start by prescribing an antacid and, if these provide insufficient effect, progress to a H₂-receptor antagonist and subsequently to a proton pump inhibitor (PPI). Testing for Helicobacter pylori should be performed in all patients with persistent or recurrent symptoms, preferably by using the monoclonal stool test. Gastroscopy should be performed with restraint in an H. pylori negative patient < 50 years with persistent or recurrent symptoms but no acute symptoms as there is only a very slight risk of malignancy. - Chronic PPI use is seen in 7% of the population and is associated with infections and osteoporosis. Phasing out of PPI use without good indication seems to be possible in 70% of patients.
《胃部症状》指南涵盖了全科医疗中成人消化不良的诊断与管理、避免不必要使用质子泵抑制剂以及在使用非甾体抗炎药（包括低剂量乙酰水杨酸衍生物）治疗期间的胃保护。在消化不良的初始阶段，反流症状和溃疡症状无需区分，因为管理方式相同：先开具抗酸剂，如果效果不佳，则升级为H₂受体拮抗剂，随后再使用质子泵抑制剂（PPI）。所有持续性或复发性症状的患者均应进行幽门螺杆菌检测，最好使用单克隆粪便检测。对于年龄小于50岁、有持续性或复发性症状但无急性症状的幽门螺杆菌阴性患者，应谨慎进行胃镜检查，因为恶性肿瘤风险非常低。 - 7%的人群长期使用PPI，这与感染和骨质疏松有关。70%的患者似乎有可能在无充分指征的情况下逐步停用PPI。
