Raju G S, Bardhan K D, Royston C, Beresford J
Department of Gastroenterology, District General Hospital, Rotherham, UK.
Aliment Pharmacol Ther. 1996 Jun;10(3):387-96. doi: 10.1111/j.0953-0673.1996.00387.x.
There is little information on the natural history of refractory gastric ulcer, defined as non-healing on cimetidine > or = 1 g daily given for at least 3 months.
A district general hospital serving an industrial population.
Patients with refractory gastric ulcer had their treatment extended and/or the dose increased, and upon healing the majority were put on maintenance treatment with cimetidine 400 mg nightly or 1 g daily and their progress was followed.
Of 536 patients with gastric ulcer, 74 (14%) were refractory. Fifty of the 74 (68%) refractory gastric ulcer patients were refractory on their very first course of cimetidine. They had no distinguishing demographic features. Healing occurred in 62 patients (84%) after a mean treatment period of 11.1 months; 28 patients required cimetidine > or = 2 g daily. Eleven of 23 (48%) patients relapsed on maintenance with cimetidine 400 mg compared with seven of 24 (29%) on 1 g daily. A total of 22 out of 62 (35%) relapsed; nine had a second refractory recurrence but none thereafter. Eleven patients were operated upon, seven for failed medical treatment. Only two patients eventually proved to have malignant disease.
Refractory gastric ulcer is uncommon, transient and rarely malignant. Most patients can be satisfactorily managed medically.
关于难治性胃溃疡自然史的信息很少，难治性胃溃疡定义为在每日服用西咪替丁≥1克至少3个月后仍未愈合。
一家为产业工人服务的区级综合医院。
难治性胃溃疡患者延长治疗时间和/或增加剂量，大多数患者愈合后采用每晚400毫克或每日1克西咪替丁进行维持治疗，并跟踪其进展。
536例胃溃疡患者中，74例（14%）为难治性。74例难治性胃溃疡患者中有50例（68%）在首个西咪替丁疗程中即为难治性。他们没有明显的人口统计学特征。平均治疗11.1个月后，62例患者（84%）愈合；28例患者需要每日服用西咪替丁≥2克。23例服用400毫克西咪替丁维持治疗的患者中有11例（48%）复发，而24例服用1克西咪替丁维持治疗的患者中有7例（29%）复发。62例患者中共有22例（35%）复发；9例出现第二次难治性复发，但此后无复发。11例患者接受了手术，7例因药物治疗失败。最终仅2例患者被证实患有恶性疾病。
难治性胃溃疡并不常见，是短暂性的，很少发生恶变。大多数患者通过药物治疗可得到满意的管理。
