- 期刊
Current Treatment of Helicobacter Pylori Infection and Peptic Ulcer Disease
幽門螺旋與消化性潰瘍之新治療法
並列摘要
Since the initial report by Warren and Marshall in 1984, Helicobacter pylon has assumed an increasingly important role in the pathogenesis of peptic ulcer disease and gastric carcinoma in all ages. A recent National Institutes of Health Consensus Development conference acknowledges the relationship between H. pylon infection and peptic ulcer disease and recommends that the medical community treat H. pylon infection in all patients with Helicobacter pylon and peptic ulcer. Although the same organism, the response to Helicobacter pylon infection in childhood differs somewhat from that seen in adults. The paediatric patient mounts a different inflammatory response, has different macroscopic appearances and has a markedly diminished peptic ulcer disease frequency compared with their adult counterparts. The appearances of antral nodulanity appear to be characteristic of Helicobacter pylon infections. The appearances, however, are unrelated to symptoms and the underlying cause for this nodularity remains obscure. Younger children with peptic ulcer diseases are more likely to be Helicobacter pylon negative. This may suggest an increased susceptibility to gastric acid or possibly a very transient Helicobacter pylon infection rather than the well described lifelong infection without treatment. It is well known that the epidemiology of Helicobacter pylon would suggest that the incidence of infection increases with age. There is also geographical variations with the incidence being higher in countries of a third world background. These epidemiological observations fly in the face of all other infections where the major period of acquisition is in childhood. There has been recent evidence to suggest that in fact the incidence in childhood is decreasing in developed countries which could support the observation that there is a decreasing positive serology with successive decades in some countries. It is felt that the most likely mode of trdnsmission of Helicobacter pylon is faecal to oral or oral to oral route. These are similar modes of transmission to Hepatitis A infections. It is obvious that most infections in childhood remain asymptomatic. It is also clear that there is no relationship between chronic recurrent abdominal pain of childhood syndrome and the presence of Helicobacter pylon infections. It remains to be seen as to who should be treated, what with and when. All of these issues will be discussed in the paper.