Khandekar S, Chandler S T, Trewby P N
Department of Medicine, Darlington Memorial Hospital NHS Trust.
J R Coll Physicians Lond. 1998 Jul-Aug;32(4):354-7.
Surgery and balloon dilatation are perceived by many as the principal treatments for peptic pyloric stenosis. We questioned whether, with the availability of modern acid suppressant treatment, this was still appropriate or whether patients could be managed with medical treatment alone.
Seventeen consecutive patients with peptic pyloric stenosis were treated with endoscopic gastric drainage, followed by oral omeprazole in 15 or cimetidine in two. Gastric emptying half times for solids and liquids were assessed in 11 of the 17 patients when they had become asymptomatic.
Endoscopic drainage and medical treatment successfully relieved symptoms in all 17 patients, although the gastric emptying studies in 11 patients still showed prolongation in eight. Symptoms resolved completely after a mean of 28 days. Five patients relapsed when changed from omeprazole to cimetidine treatment, but all responded to re-starting omeprazole. Four patients remain well on cimetidine alone.
Medical treatment preceded by endoscopic gastric drainage was effective in all patients in this series and may be the preferred choice of treatment in patients with pyloric stenosis.
许多人认为手术和球囊扩张是消化性幽门狭窄的主要治疗方法。我们质疑，在现代抑酸治疗可用的情况下，这是否仍然合适，或者患者是否可以仅通过药物治疗来管理。
连续17例消化性幽门狭窄患者接受内镜下胃引流治疗，随后15例口服奥美拉唑，2例口服西咪替丁。17例患者中有11例在无症状时评估了固体和液体的胃排空半衰期。
内镜引流和药物治疗成功缓解了所有17例患者的症状，尽管11例患者的胃排空研究仍显示8例延长。症状平均在28天后完全缓解。5例患者从奥美拉唑改为西咪替丁治疗后复发，但重新开始使用奥美拉唑后均有反应。4例患者仅使用西咪替丁情况良好。
本系列中所有患者在内镜下胃引流后进行药物治疗均有效，可能是幽门狭窄患者的首选治疗方法。
