Penston J G
Ninewells Hospital, Dundee, Scotland.
Aliment Pharmacol Ther. 1994 Aug;8(4):369-89. doi: 10.1111/j.1365-2036.1994.tb00304.x.
The long-term management of patients with peptic ulcer disease is unsatisfactory, as judged by the persistently high levels of haemorrhage, perforation and death from this condition in Western countries. Although ulcer recurrence and complications can be prevented, many patients with peptic ulcer disease fail to receive the benefits of modern therapeutic regimens. In recent years, eradication of Helicobactor pylori has been promoted as a 'cure' for peptic ulcer disease and, while such claims are premature, there can be little doubt that this treatment--when successful--dramatically improves the medium-term prognosis of ulcer patients. However, in general, clinicians have given this promising therapeutic advance a lukewarm welcome. The aim of this detailed review of the literature is to remove the uncertainty and confusion surrounding many aspects of eradication therapy. Estimates are provided of the eradication rates after either triple therapy or the combination of omeprazole plus amoxycillin, and the sources of variation in published studies are discussed. Problems associated with eradication therapy, including side effects, compliance and re-infection, are addressed in order to ascertain the extent and clinical significance of each factor. In addition, studies reporting the outcome of patients with peptic ulcer disease after eradication are assessed with reference to both ulcer recurrence and complications. The result of the review is to dissipate much of the scepticism concerning eradication therapy. However, whilst acknowledging the efficacy of eradication therapy, its limitations have also to be recognized. By itself, it does not provide the complete answer to peptic ulcer disease. For some ulcer patients, eradication therapy is the preferred option; for others, prophylactic therapy with H2-receptor antagonists is more suitable. Guidelines are proposed for the selection of patients for each alternative therapy. The crucial point is that patients with peptic ulcer--excluding the small proportion with a mild form of the disease--require positive, long-term management consisting of either continuous prophylaxis with H2-receptor antagonists or the eradication of Helicobacter pylori.
从西方国家消化性溃疡疾病导致的出血、穿孔及死亡持续高发水平来看，该疾病患者的长期管理并不理想。尽管溃疡复发及并发症可以预防，但许多消化性溃疡疾病患者未能从现代治疗方案中获益。近年来，根除幽门螺杆菌被推崇为消化性溃疡疾病的 “治愈” 方法，虽然这种说法为时过早，但毫无疑问，这种治疗方法（成功时）能显著改善溃疡患者的中期预后。然而，总体而言，临床医生对这一有前景的治疗进展反应冷淡。这篇详细的文献综述旨在消除根除治疗诸多方面存在的不确定性和困惑。文中给出了三联疗法或奥美拉唑联合阿莫西林治疗后的根除率估计，并讨论了已发表研究中的差异来源。文中还探讨了根除治疗相关的问题，包括副作用、依从性和再感染，以确定每个因素的程度和临床意义。此外，对报告根除幽门螺杆菌后消化性溃疡疾病患者结局的研究，从溃疡复发和并发症两方面进行了评估。综述结果是消除了许多对根除治疗的怀疑态度。然而，在承认根除治疗有效性的同时，也必须认识到其局限性。仅靠它并不能完全解决消化性溃疡疾病问题。对于一些溃疡患者，根除治疗是首选方案；对于另一些患者，使用H2受体拮抗剂进行预防性治疗更为合适。文中针对每种替代疗法的患者选择提出了指导原则。关键在于，消化性溃疡患者（不包括少数症状轻微的患者）需要积极的长期管理，包括持续使用H2受体拮抗剂进行预防或根除幽门螺杆菌。
