Ramsey E J, Harris A E
Johnston Willis Hospital, Richmond, Va 23235.
Arch Intern Med. 1988 Oct;148(10):2275-6.
An active 80-year-old woman without a history of peptic ulcer disease, recent nonsteroidal anti-inflammatory drug use, or smoking developed severe, symptomatic epigastric pain initially diagnosed as nonulcer dyspepsia secondary to esophagitis. Initial treatment consisted of 12 weeks of full-dose H2-receptor antagonist therapy. During this therapy the patient developed multiple gastric ulcers confirmed by endoscopy, and continued to have significant dyspeptic symptoms. An additional 16 weeks of combination therapy with ranitidine and sucralfate failed to ameliorate upper gastrointestinal symptoms, and there was significant increase in gastric ulcer size. Repeated ulcer biopsies showed no malignancy. Prior to scheduling elective gastric ulcer surgery, a trial of oral prostaglandin E1 analogue therapy was initiated with an investigational agent. Within the first three weeks of therapy, there was significant symptomatic improvement. Endoscopy of the upper gastrointestinal tract at 12 weeks revealed complete ulcer healing. This case report suggests that prostaglandin E1 analogue therapy should be considered as an alternative to elective gastric ulcer surgery for patients with refractory gastric ulcer.
一位80岁的活跃女性，无消化性溃疡病史，近期未使用非甾体抗炎药，也不吸烟，却出现了严重的上腹部疼痛症状，最初被诊断为食管炎继发的非溃疡性消化不良。初始治疗采用了为期12周的全剂量H2受体拮抗剂疗法。在此治疗期间，患者经内镜检查确诊患有多处胃溃疡，且消化不良症状持续显著。再给予雷尼替丁和硫糖铝联合治疗16周，仍未能改善上消化道症状，胃溃疡大小反而显著增加。多次溃疡活检未发现恶性病变。在安排择期胃溃疡手术前，开始试用一种研究性口服前列腺素E1类似物进行治疗。治疗的前三周内，症状就有了显著改善。12周时上消化道内镜检查显示溃疡完全愈合。本病例报告提示，对于难治性胃溃疡患者，前列腺素E1类似物疗法应被视为择期胃溃疡手术的替代方案。
