新人999如何治疗胃溃疡配图，仅供参考
TreatmentTreatment is usually directed at identifying the factors that lead to PUD. For H. pylori-associated PUD,eradication alone will lead to ulcer healing and prevent further mucosal injury. However,due to rising antibiotic resistance in H. pylori,treatment has become more difficult ). First line therapy for H. pylori eradication includes a proton pump inhibitor (PPI),clarithromycin and amoxicillin or metronidazole (for penicillin-allergic patients) for seven to 14 days. PPIs work synergistically with antibiotics to eradicate H. pylori. Due to increasing antibiotic resistance,the efficacy of triple therapy has fallen below 70% in many countries. As susceptibility testing is often not available in clinical practice,clarithromycin-based regimens should be avoided when local clarithromycin resistance rates are greater than 15%. Clarithromycin resistance rates are high (>20%) across the United States. When using clarithromycin-based triple therapy,eradication rates can be increased with use of high dose PPI and by extending the duration of treatment from seven to 14 days. For areas with high clarithromycin resistance,bismuth-containing quadruple therapy with a PPI,bismuth,tetracycline and a nitroimidazole (metronidazole or tinidazole) for 14 days or PPI,clarithromycin,amoxicillin,and a nitroimidazole for 14 days is the preferred as first line treatment. There have been issues with the cost and availability of tetracycline and the data have been mixed on whether doxycycline can be substituted. The regimens discussed above yield eradication rates greater than 90%.
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[Open in a separate window](https://ncbi.nlm.nih.gov/pmc/articles/PMC6140150/figure/f2-ms115_p0219/?report=objectonly) [Figure 2](https://ncbi.nlm.nih.gov/pmc/articles/PMC6140150/figure/f2-ms115_p0219/)
Multiple treatment regimens for H. pylori can be considered and the standard treatment duration is 14 days. The doses of the drugs used are: proton pump inhibitor (PPI,standard or double dose),clarithromycin 500 mg BID,amoxicillin 1 gm BID,bismuth subsalicylate 300 mg QID,metronidazole 500 mg TID,tetracycline 500 mg QID,levofloxacin 500 mg QD,rifabutin 300 mg QD.
All patients treated for H. pylori, should be tested to confirm eradication at least four weeks after completing therapy. Second line therapy should be prescribed if a first line regimen fails ) and should not include repeating metronidazole or clarithromycin. Furthermore,susceptibility testing should be considered after two treatment failures or after one treatment failure when endoscopy is performed (for other reasons such as follow up of gastric ulcer). If culture for H. pylori is not available to evaluate for resistance or after three recommended treatments have failed,rifabutin-based triple therapy (PPI,rifabutin,and amoxicillin) for 10 days can be considered. If symptoms do not improve after H. pylori eradication,endoscopy should be pursued if not already performed.
In NSAID- or aspirin-associated PUD,ulcers heal more than 85% of the time with 6–8 weeks of PPI therapy if the offending agent is discontinued. Ulcer healing is still attainable but delayed with continued NSAIDs use. Anti-secretory therapy can be started for prevention of PUD in patients on aspirin. Although PPIs,H2 blockers,sucralfate,and misoprostol can all be considered to treat NSAID-associated PUD,PPIs are far more effective than other agents. Sucralfate is effective for treating NSAID-associated duodenal ulcers but not for the treatment or prevention of NSAID-associated gastric ulcers. In addition to its poor efficacy,misoprostol is often limited by its side effect profile,which includes gastrointestinal upset and abortifacient reactions. In cases of refractory ulcers,both drug compliance with PPI use and inadvertent use of NSAIDs should be explored. All gastric ulcers require repeat endoscopy in six to eight weeks to evaluate for healing. If a gastric ulcer is not healed,biopsies must be taken at time of repeat endoscopy to rule out gastric cancer. For refractory ulcers,doubling the PPI dose can be recommended for six to eight weeks,although the evidence supporting this is weak. Furthermore,evaluating for false-negative H. pylori testing (via serology),malignancies,infections,Crohn’s disease,vasculitis,upper abdominal radiotherapy,cocaine use,and Zollinger-Ellison syndrome should be considered for ulcers that have been treated appropriately and have not healed.","department":"
