2020年谁需要胃保护？
Who Needs Gastroprotection in 2020?
作者信息
Kanno Takeshi, Moayyedi Paul
机构信息
Division of Gastroenterology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 Japan.
Farncombe Family Digestive Health Institute, McMaster University, Hamilton, Ontario Canada.
出版信息
Curr Treat Options Gastroenterol. 2020;18(4):557-573. doi: 10.1007/s11938-020-00316-9. Epub 2020 Nov 11.
PURPOSE OF REVIEW
Peptic ulcer disease (PUD) is a recognized complication of non-steroidal anti-inflammatory drugs (NSAIDs). Stress ulcers are a concern for intensive care unit (ICU) patients; PUD is also an issue for patients taking anticoagulation. test and treat is an option for patients starting NSAID therapy, and proton pump inhibitors (PPIs) may reduce PUD in NSAID patients and other high-risk groups.
RECENT FINDINGS
There are a large number of trials that demonstrate that eradication reduces PUD in NSAID patients. PPI is also effective at reducing PUD in this group and is also effective in ICU patients and those on anticoagulants. The effect is too modest for PPI to be recommended in everyone, and more research is needed as to which groups would benefit the most. Increasing age, past history of PUD, and comorbidity are the most important risk factors.
SUMMARY
test and treat should be offered to older patients starting NSAIDS, while PPIs should be prescribed to patients that are at high risk of developing PUD and at risk of dying from PUD complications.
综述目的
消化性溃疡病（PUD）是公认的非甾体抗炎药（NSAIDs）并发症。应激性溃疡是重症监护病房（ICU）患者关注的问题；PUD也是服用抗凝剂患者面临的问题。对于开始NSAID治疗的患者，检测和治疗是一种选择，质子泵抑制剂（PPIs）可能会减少NSAID患者及其他高危人群中的PUD。
最新发现
大量试验表明根除幽门螺杆菌可减少NSAID患者的PUD。PPI在该组中也能有效减少PUD，对ICU患者和服用抗凝剂的患者也有效。PPI的效果过于有限，无法推荐给所有人，对于哪些人群受益最大还需要更多研究。年龄增加、PUD既往史和合并症是最重要的危险因素。
总结
对于开始使用NSAIDs的老年患者应提供检测和治疗，而PPI应开给有发生PUD高风险和有死于PUD并发症风险的患者。
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