Misiewicz J J
Department of Gastroenterology and Nutrition, Central Middlesex Hospital, London, UK.
Eur J Gastroenterol Hepatol. 1997 Apr;9 Suppl 1:S17-20; discussion S20-1, S27-9.
The discovery of Helicobacter pylori has opened new opportunities in the management of gastrointestinal disorders, with the cure of chronic ulcer disease now being possible for the first time. The 1994 United States National Institutes of Health Consensus Conference recommended that patients with duodenal or gastric ulcers unrelated to the use of non-steroidal anti-inflammatory drugs (NSAID) should be given eradication therapy. These guidelines were refined at a conference held recently in Maastricht. The updated guidelines strongly recommend treatment in patients with duodenal or gastric ulcer disease, low-grade mucosa-associated lymphoid tissue (MALT) gastric lymphoma, gastritis with severe macro- or microscopic changes and after resection of early gastric cancer. Despite a lack of hard scientific evidence, the guidelines also suggest that eradication treatment is advisable in patients with unequivocally diagnosed functional dyspepsia, a family history of gastric cancer, long-term treatment with proton-pump inhibitors for gastro-oesophageal reflux disease (GORD), planned or existing NSAID treatment, after gastric surgery for ulcer or cancer, or if the patient wants to be treated. Many different therapeutic regimens have been used previously, but at present the best treatment is proton-pump inhibitor-based triple therapy, comprising a proton-pump inhibitor plus two drugs out of clarithromycin, a nitroimidazole and amoxycillin. One-week low-dose triple therapy cures 85-95% of infected patients.
幽门螺杆菌的发现为胃肠疾病的治疗带来了新机遇，慢性溃疡病首次有了治愈的可能。1994年美国国立卫生研究院共识会议建议，十二指肠溃疡或胃溃疡患者若与使用非甾体抗炎药（NSAID）无关，应接受根除治疗。这些指南在最近于马斯特里赫特召开的会议上得到了完善。更新后的指南强烈建议，十二指肠或胃溃疡病患者、低度黏膜相关淋巴组织（MALT）胃淋巴瘤患者、有严重宏观或微观变化的胃炎患者以及早期胃癌切除术后患者应接受治疗。尽管缺乏确凿的科学证据，但指南还建议，明确诊断为功能性消化不良的患者、有胃癌家族史的患者、因胃食管反流病（GORD）长期接受质子泵抑制剂治疗的患者、计划使用或正在使用NSAID的患者、因溃疡或癌症接受胃手术后的患者，或者患者希望接受治疗时，根除治疗是可取的。此前曾使用过许多不同的治疗方案，但目前最佳治疗方法是以质子泵抑制剂为基础的三联疗法，包括一种质子泵抑制剂加克拉霉素、硝基咪唑和阿莫西林中的两种药物。一周的低剂量三联疗法可治愈85%至95%的感染患者。
