Fletcher D R
University Department of Surgery, Fremantle Hospital, Australia.
Aust N Z J Surg. 1997 Feb-Mar;67(2-3):75-80. doi: 10.1111/j.1445-2197.1997.tb01908.x.
While surgery has the potential to cure peptic disease (ulceration and reflux), the development in the 1970s of H2 receptor antagonists saw them replace surgery in the management of peptic symptoms, controlling disease while the medication was taken. Medical cure at least in the case of a duodenal ulcer is now also possible by the use of anti-Helicobacter therapy.
Australian Pharmaceutical Benefits Scheme (PBS) and Medicare data on the treatment of peptic disease were reviewed.
The data showed that medical cure of duodenal ulcer is rarely attempted. While elective surgical treatment for duodenal ulcer, highly selective vagotomy, has decreased 10-fold in 10 years, prescriptions for antisecretory agents (H2 and proton pump) are doubling every 2 years (increasing from 6.7 to 7.8% of PBS budget). Meanwhile upper gastrointestinal endoscopy rates are doubling every 5 years. By comparison, the most appropriate treatment, anti-Helicobacter therapy, is prescribed at 1/50th the rate of antisecretory agents and over 2 years decreased to 1/80th. Antisecretory treatment has not been effective in reducing mortality from duodenal ulcer, at least not in New South Wales.
If the principle of treatment is to decrease cost and prevent complications by curing duodenal ulcer, then current practice is a failure. A management algorithm for peptic symptoms which has the potential to relieve symptoms, cure ulcer when present, minimize surgery and reduce complications and cost is proposed for the purpose of debate.
虽然手术有可能治愈消化性疾病（溃疡和反流），但20世纪70年代H2受体拮抗剂的出现使其在消化性症状管理中取代了手术，在服药期间控制疾病。现在，使用抗幽门螺杆菌疗法也至少有可能治愈十二指肠溃疡。
回顾了澳大利亚药品福利计划（PBS）和医疗保险关于消化性疾病治疗的数据。
数据显示，很少尝试通过药物治愈十二指肠溃疡。虽然十二指肠溃疡的选择性手术治疗，即高选择性迷走神经切断术，在10年内减少了10倍，但抗分泌药物（H2和质子泵抑制剂）的处方量每两年翻一番（从PBS预算的6.7%增加到7.8%）。与此同时，上消化道内镜检查率每5年翻一番。相比之下，最合适的治疗方法，即抗幽门螺杆菌疗法，其处方量仅为抗分泌药物的1/50，且在两年内降至1/80。至少在新南威尔士州，抗分泌治疗在降低十二指肠溃疡死亡率方面并不有效。
如果治疗原则是通过治愈十二指肠溃疡来降低成本并预防并发症，那么目前的做法是失败的。为了进行讨论，提出了一种针对消化性症状的管理算法，该算法有可能缓解症状、治愈现有的溃疡、尽量减少手术并降低并发症和成本。
