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1、Departmentofgastroenterology,SecondAffiliatedHospitalofNanjingMedicalUniversityJiGuozhong（季国忠）SeveralProblemsRelativetoPepticUlcerDisease南京医科大学第二附属医院DefinitionIntroductionofpepticulcer(PU)Ulcersaredefectsinthegastrointestinalmucosathatpenetratemucosa,submucosaandthemuscularismucosaGUDU南京医科大学第二附属医院Ep
2、idemiologyIntroductionofpepticulcer(PU)About5~10percentofallindividualsdevelopPuintheirlifetime.4~8millionpeople350,000newcaseseachyearintheU.S.ButinChina?DuismorecommonthanGu.Introductionofpepticulcer(PU)Etiology(Causes)pH(hydrochloricacidandpepsin)Hp(Helicobacterpylori)NSAIDSSmoking,tea,coffee,str
3、ess(emotion)南京医科大学第二附属医院1910,SchwartzNoacidNoulcer1983Marshall、WarrenNoacidNoHpNoulcer(nonsteroidalanti—inflammatorydrugs)Itisthemostcommonchronicbacterialinfectioninhumans.Aboutone-halfoftheworld’spopulationareinfectedwithHp.Itdisruptsaprotectivelayerofmucousanditsenzymesandtoxinscancausestomachand
4、duodenumcellsinjury→developulcerormoreseriousproblems—CancerDefensivefactorsAggressivefactors南京医科大学第二附属医院Introductionofpepticulcer(PU)AggressivefactorsDefensivefactorsMechanismsThereisaneffectivebalancebetweenthedefensivefactorsandaggressive(damage)factors,Disruptionofthisbalanceleadstopepticulcer.南
5、京医科大学第二附属医院Introductionofpepticulcer(PU)MechanismsAggressivefactorsDefensivefactorsacid,pepsin,bile,pancreaticenzymes,Hp,etalbicarbonate,mucus,mucosalbloodflow,cellrenewal,etal南京医科大学第二附属医院Introductionofpepticulcer(PU)SymptomsPain(70percent)Nausea(50percent)Vomiting(20percent)Weightloss(20percent)Ble
6、eding(15percent)南京医科大学第二附属医院DiagnosisIntroductionofpepticulcer(PU)basesonthehistoryandphysicalexaminationanddependsonradiographyorendoscopyEndoscopyismoreaccurateandallowsdirectedbiopsy,cytologicstudyandHpdiagnosis.南京医科大学第二附属医院TreatmentstrategyNocomplications--medicaltherapy.Twicedramaticevolutions1
7、970s-1980s：H2RA（Cimetidine）PPI（Omeprazole）1980s-2000s:HPInselectingadrugwithwhichtotreatapatientwithpu,fourfactorsmustbeconsidered:effectiveness,safety,convenience,cost.A:PPI+twoantibioticsB:CBS+twoan
