新型幽门螺杆菌根治方案
已经对一种包含左氧氟沙星、奥美拉唑、硝唑尼特和多西环素 (levofloxacin, omeprazole, nitazoxanide, and doxycycline; LOAD) 的四联方案进行了研究;然而,在推荐使用该非常规的昂贵治疗方案前,需要进行更多试验。[23]Moayyedi PM, Lacy BE, Andrews CN, et al. ACG and CAG clinical guideline: management of dyspepsia. Am J Gastroenterol. 2017 Jul;112(7):988-1013.https://www.nature.com/articles/ajg2017154http://www.ncbi.nlm.nih.gov/pubmed/28631728?tool=bestpractice.com[25]Chey WD, Leontiadis GI, Howden CW, et al. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017 Feb;112(2):212-39.http://gi.org/wp-content/uploads/2017/02/ACGManagementofHpyloriGuideline2017.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/28071659?tool=bestpractice.com
口服质子泵抑制剂治疗活动性出血溃疡
一项 meta 分析报告,在随机接受口服或静脉使用质子泵抑制剂来治疗出血性消化性溃疡的患者中,出血复发率相当(在 30 天随访期间)。[43]Jian Z, Li H, Race NS, et al. Is the era of intravenous proton pump inhibitors coming to an end in patients with bleeding peptic ulcers? Meta-analysis of the published literature. Br J Clin Pharmacol. 2016 Jun 12;82(3):880-9.www.doi.org/10.1111/bcp.12866http://www.ncbi.nlm.nih.gov/pubmed/26679691?tool=bestpractice.com对于由消化性溃疡病导致活动性出血但无法接受静脉输注质子泵抑制剂或所在机构无该资源的患者,可以考虑使用口服质子泵抑制剂治疗。[44]Sachar H, Vaidya K, Laine L. Intermittent vs continuous proton pump inhibitor therapy for high-risk bleeding ulcers: a systematic review and meta-analysis. JAMA Intern Med. 2014 Nov;174(11):1755-62.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4415726/http://www.ncbi.nlm.nih.gov/pubmed/25201154?tool=bestpractice.com