胃及十二指肠潰瘍：修订间差异

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溃疡多为单个，病發於胃時稱為[[胃溃疡]]（gastric ulcer），出現在十二指腸則稱[[十二指腸溃疡]]（duodenal ulcer）。
溃疡多为单个，病發於胃時稱為[[胃溃疡]]（gastric ulcer），出現在十二指腸則稱[[十二指腸溃疡]]（duodenal ulcer）。

<!-- 定義與症狀 -->
'''消化性潰瘍'''（{{lang-en|peptic ulcer disease}}、{{lang-en|peptic ulcer}}，簡稱PUD），又稱'''胃潰瘍'''（{{lang-en|stomach ulcer}}。這是指[[胃]]或[[小腸]]前段，有時也包含了[[食道下端]]的黏膜損傷[1][2]。在胃發生的潰瘍稱作'''胃潰瘍'''，在小腸的開頭部分所發生的潰瘍則是'''十二指腸潰瘍'''。最常見的症狀是會因為吃東西而改善的上腹痛，或者晚上因肚子痛而醒來。胃潰瘍的疼痛大多被用「燒灼感」或「悶痛」描述，其他常見的症狀還包括打嗝、嘔吐、不明原因的體重減輕、或是胃口不佳，但年紀較大的患者中約有三分之一完全沒有症狀[1]。胃潰瘍若不處理，可能會演變成出血、穿孔、或是胃出口阻塞，出血的發生率約為15%。
'''Peptic ulcer disease''' ('''PUD'''), also known as a '''peptic ulcer''' or '''stomach ulcer''', is a break in the lining of the [[stomach]], first part of the [[small intestine]], or occasionally the lower [[esophagus]].<ref name=Na2011>{{cite journal|last1=Najm|first1=WI|title=Peptic ulcer disease.|journal=Primary care|date=September 2011|volume=38|issue=3|pages=383–94, vii|pmid=21872087}}</ref><ref>{{cite web|title=Definition and Facts for Peptic Ulcer Disease|url=http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/peptic-ulcer/Pages/definition-facts.aspx|website=http://www.niddk.nih.gov/|accessdate=28 February 2015}}</ref> An ulcer in the stomach is known as a '''gastric ulcer''' while that in the first part of the intestines is known as a '''duodenal ulcer'''.<!-- <ref name=Na2011/> --> The most common symptoms are waking at night with [[epigastrium|upper abdominal pain]] or upper abdominal pain that improves with eating.<!-- <ref name=Na2011/> --> The pain is often described as a [[dyspepsia|burning]] or dull ache.<!-- <ref name=Na2011/> --> Other symptoms include [[belching]], vomiting, weight loss, or [[Anorexia (symptom)|poor appetite]].<!-- <ref name=Na2011/> --> About a third of older people have no symptoms.<ref name=Na2011/> Complications may include [[gastrointestinal bleeding|bleeding]], [[gastrointestinal perforation|perforation]], and [[gastric outlet obstruction|blockage of the stomach]].<!-- <ref name=Mil2011/> --> Bleeding occurs in as many as 15% of people.<ref name=Mil2011/>

<!-- 病因與診斷 -->
常見的致病因子包括[[幽門螺旋桿菌]]以及[[非固醇類抗發炎藥]]。其他較少見的致病因子包括[[抽煙]]、嚴重疾病造成的壓力、[[貝賽特氏症]]、[[胃泌素瘤]]、[[克隆氏症]]以及[[肝硬化]]。高齡者服用非固醇類抗發炎藥更容易造成潰瘍。當臨床症狀出現時，可以進行[[內視鏡]]以及[[鋇劑吞嚥檢查法]]進行檢查。臨床上可以抽血檢測是否有幽門螺旋桿菌的抗體、進行尿素呼氣試驗、進行糞便檢查或進行胃活組織檢查來診斷是否有幽門螺旋桿菌的感染。造成類似症狀的其他病症包括胃癌、冠狀動脈心臟疾病、胃粘膜發炎以及膽囊發炎。
Common causes include the [[bacteria]], ''[[Helicobacter pylori]]'' and [[non-steroidal anti-inflammatory drug]]s (NSAIDs).<ref name=Na2011/> Other less common causes include [[tobacco smoking]], stress due to serious illness, [[Behcet disease]], [[Zollinger-Ellison syndrome]], [[Crohn disease]] and [[liver cirrhosis]], among others.<ref name=Na2011/><ref name=St2002>{{cite journal|last1=Steinberg|first1=KP|title=Stress-related mucosal disease in the critically ill patient: risk factors and strategies to prevent stress-related bleeding in the intensive care unit.|journal=Critical care medicine|date=June 2002|volume=30|issue=6 Suppl|pages=S362-4|pmid=12072662}}</ref> Older people are more sensitive to the ulcer causing effects of NSAIDs.<!-- <ref name=Na2011/> --> The diagnosis is typically suspected due to the presenting symptoms with confirmation by either [[endoscopy]] or [[barium swallow]].<!-- <ref name=Na2011/> --> ''H. pylori'' can be diagnosed by testing the blood for [[antibodies]], a [[urea breath test]], testing the stool for signs of the bacteria, or a [[biopsy]] of the stomach.<!-- <ref name=Na2011/> --> Other conditions that produce similar symptoms include [[gastric cancer|stomach cancer]], [[coronary heart disease]], and [[gastritis|inflammation of the stomach lining]] or [[cholelithiasis|gallbladder]].<ref name=Na2011/>

<!-- 預防與治療 -->
對引起或預防潰瘍的層面而言，飲食內容並非重要的影響因子。較常見的治療方式包含：戒菸、戒酒、停用[[非類固醇消炎止痛藥]]（{{lang-en|Nonsteroidal anti-inflammatory drug，簡稱NSAIDs}}），以及使用抑制胃酸的藥物。常見的治療藥物像是[[氫離子幫浦阻斷劑]]（{{lang-en|Proton-pump inhibitor，簡稱PPI}}）或[[H2受體阻抗劑]]（{{lang-en|H2 antagonist}}，俗稱{{lang-en|H2 blocker}}），通常建議的基本用藥療期為四週。[[幽門螺旋桿菌]]造成的潰瘍，通常會以[[安默西林]]（{{lang-en|Amoxicillin}}）、（{{le|Clarithromycin中文翻譯藥物名|Clarithromycin}}）與[[氫離子幫浦阻斷劑]]作為藥物組合治療�；但因[[抗生素抗藥性]]與日俱增，此療法並非絕對有效。出血性潰瘍有時會以[[內視鏡]]進行治療，而外科手術只會在內視鏡治療無法處理時進行。
[[Diet]] does not play an important role in either causing or preventing ulcers.<ref>{{cite web|title=Eating, Diet, and Nutrition for Peptic Ulcer Disease|url=http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/peptic-ulcer/Pages/eating-diet-nutrition.aspx|website=http://www.niddk.nih.gov|accessdate=28 February 2015}}</ref> Treatment includes stopping smoking, stopping NSAIDs, stopping [[alcohol]], and medications to decrease stomach acid.<!-- <ref name=Na2011/> --> The medication used to decrease acid is usually either a [[proton pump inhibitor]] (PPI) or an [[H2 blocker]] with four weeks of treatment initially recommended.<ref name=Na2011/> Ulcers due to ''H. pylori'' are treated with a combination of medications such as [[amoxicillin]], [[clarithromycin]], and a PPI.<!-- <ref name=Wang2011/> --> [[Antibiotic resistance]] is increasing and thus treatment may not always be effective.<ref name=Wang2011/> Bleeding ulcers may be treated by [[endoscopy]], with open surgery typically only used in cases in which it is not successful.<ref name=Mil2011/>

<!-- 流行病學與歷史-->
在所有人口中，胃潰瘍的盛行率大約為4%。大約有10%的人會在一生中產生胃潰瘍。胃潰瘍從1990年造成 327,000人死亡降低至2013年造成301,000人死亡。胃潰瘍穿孔在1670年第一次在{{le|英國的亨麗埃塔公主|Henrietta of England}}身上被敘述。幽門桿菌是在1981年由[[巴里·馬歇爾]]以及[[罗宾·沃伦]]發現。
Peptic ulcers are present in around 4% of the population.<ref name=Na2011/> About 10% of people develop a peptic ulcer at some point in their life.<ref name=Snow2008>{{Cite journal |author=Snowden FM |title=Emerging and reemerging diseases: a historical perspective |journal=Immunol. Rev. |volume=225 |issue= 1 |pages=9–26 |date=October 2008 |pmid=18837773 |doi=10.1111/j.1600-065X.2008.00677.x |url=}}</ref> They resulted in 301,000 deaths in 2013 down from 327,000 deaths in 1990.<ref name=GDB2013>{{cite journal|last1=GBD 2013 Mortality and Causes of Death|first1=Collaborators|title=Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.|journal=Lancet|date=17 December 2014|pmid=25530442|doi=10.1016/S0140-6736(14)61682-2}}</ref> The first description of a perforated peptic ulcer was in 1670 in Princess [[Henrietta of England]].<ref name=Mil2011>{{cite journal|last1=Milosavljevic|first1=T|last2=Kostić-Milosavljević|first2=M|last3=Jovanović|first3=I|last4=Krstić|first4=M|title=Complications of peptic ulcer disease.|journal=Digestive diseases (Basel, Switzerland)|date=2011|volume=29|issue=5|pages=491–3|pmid=22095016}}</ref> ''H. pylori'' was first discovered in 1981 by [[Barry Marshall]] and [[Robin Warren]].<ref name=Wang2011>{{cite journal|last1=Wang|first1=AY|last2=Peura|first2=DA|title=The prevalence and incidence of Helicobacter pylori-associated peptic ulcer disease and upper gastrointestinal bleeding throughout the world.|journal=Gastrointestinal endoscopy clinics of North America|date=October 2011|volume=21|issue=4|pages=613–35|pmid=21944414}}</ref>


== 症状 ==
== 症状 ==

2015年12月11日 (五) 00:45的版本

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胃及十二指肠潰瘍
Deep gastric ulcer
症状epigastric pain[*]、胸口灼熱、黑便[*]、呕血
类型消化道疾病[*]、duodenal disease[*]、疾病
肇因幽门螺杆菌感染[*]、非甾体抗炎药
分类和外部资源
醫學專科胃肠学
ICD-11DA61
ICD-10K25-K27
ICD-9-CM531-534
DiseasesDB9819
MedlinePlus[1]
eMedicinemed/1776 ped/2341
MeSHD010437
[编辑此条目的维基数据]

胃及十二指肠潰瘍是指胃壁、幽门或十二指肠发生溃疡病变。

溃疡多为单个，病發於胃時稱為胃溃疡（gastric ulcer），出現在十二指腸則稱十二指腸溃疡（duodenal ulcer）。

消化性潰瘍（英語：peptic ulcer disease、英語：peptic ulcer，簡稱PUD），又稱胃潰瘍（英語：stomach ulcer。這是指胃或小腸前段，有時也包含了食道下端的黏膜損傷[1][2]。在胃發生的潰瘍稱作胃潰瘍，在小腸的開頭部分所發生的潰瘍則是十二指腸潰瘍。最常見的症狀是會因為吃東西而改善的上腹痛，或者晚上因肚子痛而醒來。胃潰瘍的疼痛大多被用「燒灼感」或「悶痛」描述，其他常見的症狀還包括打嗝、嘔吐、不明原因的體重減輕、或是胃口不佳，但年紀較大的患者中約有三分之一完全沒有症狀[1]。胃潰瘍若不處理，可能會演變成出血、穿孔、或是胃出口阻塞，出血的發生率約為15%。 Peptic ulcer disease (PUD), also known as a peptic ulcer or stomach ulcer, is a break in the lining of the stomach, first part of the small intestine, or occasionally the lower esophagus.[1][2] An ulcer in the stomach is known as a gastric ulcer while that in the first part of the intestines is known as a duodenal ulcer. The most common symptoms are waking at night with upper abdominal pain or upper abdominal pain that improves with eating. The pain is often described as a burning or dull ache. Other symptoms include belching, vomiting, weight loss, or poor appetite. About a third of older people have no symptoms.[1] Complications may include bleeding, perforation, and blockage of the stomach. Bleeding occurs in as many as 15% of people.[3]

常見的致病因子包括幽門螺旋桿菌以及非固醇類抗發炎藥。其他較少見的致病因子包括抽煙、嚴重疾病造成的壓力、貝賽特氏症、胃泌素瘤、克隆氏症以及肝硬化。高齡者服用非固醇類抗發炎藥更容易造成潰瘍。當臨床症狀出現時，可以進行內視鏡以及鋇劑吞嚥檢查法進行檢查。臨床上可以抽血檢測是否有幽門螺旋桿菌的抗體、進行尿素呼氣試驗、進行糞便檢查或進行胃活組織檢查來診斷是否有幽門螺旋桿菌的感染。造成類似症狀的其他病症包括胃癌、冠狀動脈心臟疾病、胃粘膜發炎以及膽囊發炎。 Common causes include the bacteria, Helicobacter pylori and non-steroidal anti-inflammatory drugs (NSAIDs).[1] Other less common causes include tobacco smoking, stress due to serious illness, Behcet disease, Zollinger-Ellison syndrome, Crohn disease and liver cirrhosis, among others.[1][4] Older people are more sensitive to the ulcer causing effects of NSAIDs. The diagnosis is typically suspected due to the presenting symptoms with confirmation by either endoscopy or barium swallow. H. pylori can be diagnosed by testing the blood for antibodies, a urea breath test, testing the stool for signs of the bacteria, or a biopsy of the stomach. Other conditions that produce similar symptoms include stomach cancer, coronary heart disease, and inflammation of the stomach lining or gallbladder.[1]

對引起或預防潰瘍的層面而言，飲食內容並非重要的影響因子。較常見的治療方式包含：戒菸、戒酒、停用非類固醇消炎止痛藥（英語：Nonsteroidal anti-inflammatory drug，簡稱NSAIDs），以及使用抑制胃酸的藥物。常見的治療藥物像是氫離子幫浦阻斷劑（英語：Proton-pump inhibitor，簡稱PPI）或H2受體阻抗劑（英語：H2 antagonist，俗稱英語：H2 blocker），通常建議的基本用藥療期為四週。幽門螺旋桿菌造成的潰瘍，通常會以安默西林（英語：Amoxicillin）、（Clarithromycin中文翻譯藥物名（英语：Clarithromycin））與氫離子幫浦阻斷劑作為藥物組合治療�；但因抗生素抗藥性與日俱增，此療法並非絕對有效。出血性潰瘍有時會以內視鏡進行治療，而外科手術只會在內視鏡治療無法處理時進行。 Diet does not play an important role in either causing or preventing ulcers.[5] Treatment includes stopping smoking, stopping NSAIDs, stopping alcohol, and medications to decrease stomach acid. The medication used to decrease acid is usually either a proton pump inhibitor (PPI) or an H2 blocker with four weeks of treatment initially recommended.[1] Ulcers due to H. pylori are treated with a combination of medications such as amoxicillin, clarithromycin, and a PPI. Antibiotic resistance is increasing and thus treatment may not always be effective.[6] Bleeding ulcers may be treated by endoscopy, with open surgery typically only used in cases in which it is not successful.[3]

在所有人口中，胃潰瘍的盛行率大約為4%。大約有10%的人會在一生中產生胃潰瘍。胃潰瘍從1990年造成 327,000人死亡降低至2013年造成301,000人死亡。胃潰瘍穿孔在1670年第一次在英國的亨麗埃塔公主身上被敘述。幽門桿菌是在1981年由巴里·馬歇爾以及罗宾·沃伦發現。 Peptic ulcers are present in around 4% of the population.[1] About 10% of people develop a peptic ulcer at some point in their life.[7] They resulted in 301,000 deaths in 2013 down from 327,000 deaths in 1990.[8] The first description of a perforated peptic ulcer was in 1670 in Princess Henrietta of England.[3] H. pylori was first discovered in 1981 by Barry Marshall and Robin Warren.[6]

症状

临床特点为慢性、周期性的上腹疼痛，胃溃疡的痛多发生在进食后半小时至一小时，胃酸增多或正常；十二指腸溃疡的痛则多出现于食后三至四小时， 胃酸一般显著增多。

輕微者有反胃、嘔吐、疼痛等症狀，嚴重者可因消化道大量出血（呕血或便血）导致休克。

病理机制

过去有人误以为胃及十二指腸潰瘍是因胃、十二指腸等黏膜因胃酸过多而受到侵蝕（消化掉自己的胃粘膜）而形成表面組織損傷，故误称 为消化性溃疡（peptic ulcer）。近年发现幽门螺旋菌才是最主要的致病原因，发现者因此获诺贝尔医学奖。

輕微的胃潰瘍

訛誤

胃及十二指肠潰瘍是一常见消化系统疾病。過去有普遍認為發病原因如下：

诸如长期使用粗糙、刺激性食物，不注意饮食结构，以及长期服用如阿司匹林（Aspirin）、强的松、酒精等导致胃粘膜的破坏使得胃肠道的自我保护能力大幅下降，与此同时，具有“胃蛋白酶”以及胃酸的胃液即可较轻易的穿透胃粘膜屏障，以消化胃肠道 的自身组织，形成溃疡。

另外，消化性溃疡也可由消化液的分泌增加，致使胃酸、胃蛋白酶的量超出胃粘膜所能应对的程度，而导致溃疡的形成。幽门螺旋杆菌，也可以诱 发消化性溃疡（通过刺激胃酸分泌等）。此外，心理因素，精神高度紧张也可引起消化行溃疡，家族遺傳，父母或近親中有潰瘍的人，較易罹患。大部 分患者感覺有燒灼感、悶痛、脹痛、飢餓痛、感到疼痛。

幽門螺旋桿菌的發現

1981年兩位澳洲醫師巴裡·馬歇爾（Barry J. Marshall）和羅賓·沃倫（Robin Warren）發現幽門螺旋桿菌才是造成胃潰瘍病因，而非過去熟知的壓力或生活不正常等因素。這些病菌進入體內之後，寄生在胃和十二指腸的保護黏膜內，削弱黏膜層的保護作用。為了證實胃潰瘍因細菌而起，馬歇爾喝下含幽門桿菌的飲料，尽管并没有导致胃溃疡，马歇尔得了急性胃炎，从而验证了幽门螺旋杆菌是胃病的主要致病因素。不久就治好了。

這個重大發現使得人类重新认识溃疡病成因，使患者真正获得有效治疗。发现者因此獲2005年諾貝爾醫學獎。[9]

注意事项

胃及十二指肠潰瘍患者要注意恢復生活及飲食規律，防止疲勞，注意休息。注意要保持良好的精神，因為精神對胃粘膜的修復有很大的影響。飲食一定要注意定時定量，多吃易消化的溫和食品如粥、麵食等。忌食辛辣、忌煙酒、咖啡、碳酸飲料等，避免吃粗糙、糯米類等不易消化之食物。對於處於阿司匹林、強的松等強胃腸道刺激藥物療程間發生的胃潰瘍，應儘早於醫師指示下停藥。

患者應在医生指导下正确用药，保持良好的饮食习惯、三餐定時定量，且盡量避免抽煙、喝烈酒、长期熬夜，减少对过浓咖啡等刺激性食物的依赖。

治疗原则

治疗本病可对上述病理因素，对因治疗，具体可使用“制酸剂”、“胃粘膜保护剂”、以及抗幽门螺杆菌的药物。

胃及十二指肠潰瘍本身对人体并无大碍，只有极少数胃及十二指肠潰瘍可能发展为癌症，引起消化道出血、胃穿孔、幽门梗阻等严重的继发症。「 胃癌」与「胃潰瘍」之臨床有相似表现，但可以用胃镜、钡餐透视尤其病理切片诊断鉴别，以免延误最佳治疗时机。

参见

参考資料

  1. ^ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Najm, WI. Peptic ulcer disease.. Primary care. September 2011, 38 (3): 383–94, vii. PMID 21872087. 
  2. ^ Definition and Facts for Peptic Ulcer Disease. http://www.niddk.nih.gov/. [28 February 2015]. 
  3. ^ 3.0 3.1 3.2 Milosavljevic, T; Kostić-Milosavljević, M; Jovanović, I; Krstić, M. Complications of peptic ulcer disease.. Digestive diseases (Basel, Switzerland). 2011, 29 (5): 491–3. PMID 22095016. 
  4. ^ Steinberg, KP. Stress-related mucosal disease in the critically ill patient: risk factors and strategies to prevent stress-related bleeding in the intensive care unit.. Critical care medicine. June 2002, 30 (6 Suppl): S362–4. PMID 12072662. 
  5. ^ Eating, Diet, and Nutrition for Peptic Ulcer Disease. http://www.niddk.nih.gov. [28 February 2015].  外部链接存在于|website= (帮助)
  6. ^ 6.0 6.1 Wang, AY; Peura, DA. The prevalence and incidence of Helicobacter pylori-associated peptic ulcer disease and upper gastrointestinal bleeding throughout the world.. Gastrointestinal endoscopy clinics of North America. October 2011, 21 (4): 613–35. PMID 21944414. 
  7. ^ Snowden FM. Emerging and reemerging diseases: a historical perspective. Immunol. Rev. October 2008, 225 (1): 9–26. PMID 18837773. doi:10.1111/j.1600-065X.2008.00677.x. 
  8. ^ GBD 2013 Mortality and Causes of Death, Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.. Lancet. 17 December 2014. PMID 25530442. doi:10.1016/S0140-6736(14)61682-2. 
  9. ^ 颜亮 张小军《"埋藏"肠胃中>的诺贝尔奖 幽门螺杆菌发现》
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取自“https://zh.wikipedia.org/w/index.php?title=胃及十二指肠潰瘍&oldid=38281556”