第6巻 2010年2月　第1号

■綜説

消化性潰瘍の現状
三宅　一昌, 楠　正典, 進藤　智隆, 植木　信江, 河越　哲郎, 二神　生爾, 津久井　拓, 坂本　長逸
日本医科大学大学院医学研究科病態制御腫瘍内科学

Current Status of Gastroduodenal Ulcers
Kazumasa Miyake, Masafumi Kusunoki, Tomotaka Shindo, Nobue Ueki, Tetsuro Kawagoe, Seiji Futagami, Taku Tsukui and Choitsu Sakamoto
Department of Pathophysiological Management/Medical Oncology, Graduate School of Medicine, Nippon Medical School

Nonsteroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori infection are the two major causes of peptic ulcers. At present, H. pylori eradication is widely recommended as the most effective treatment for preventing the recurrence of peptic ulcer. In Japan, the first-line regimen for H. pylori eradication, which consists of a proton pump inhibitors (PPI), amoxicillin, and clarithromycin (CAM), was approved in December 2000. However, the number of CAM-resistant strains causing eradication failure by triple therapy including CAM has been increasing. Previous studies have demonstrated that both misoprostol and PPIs are effective for preventing and curing NSAID-associated mucosal injuries. Proton-pump inhibitors have been reported to be better tolerated than misoprostol. In addition, histamine-H2 receptor antagonists (H2RA), when administered at high doses, have preventive effects. However, Japanese patients are expected that not high-dose but even standard-dose H2RAs are effective, because Japanese originally intend to be lower acidity than Westernaers, and have often severe corpus atrophy. For users of NSAIDs, H. pylori infection may additively or synergistically increase the risk of peptic ulcers or serious ulcer complications. H. pylori eradication has been shown to substantially decrease the recurrence rate of peptic ulcers in new NSAID users, but the efficacy in patients with chronic NSAID ulcers is controversial.

日医大医会誌 2010; 6(1), 7-12

Key words
peptic ulcers, Helicobacter pylori, nonsteroidal anti-inflammatory drugs

Correspondence to
Kazumasa Miyake, MD, PhD, Department of Internal Medicine Division of Gastroenterology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku Tokyo 113-8603, Japan
E-mail：km366@nms.ac.jp

受付：2009年8月28日　受理：2009年9月11日