臨牀消化器内科 Vol.14 No.12(2-2)


特集名 薬物治療をめぐるControversy --上部消化管
題名 Peptic Ulcer治療の第一選択は (2) H2-RA
発刊年月 1999年 11月
著者 小林 壮光 手稲ルカ病院内科
著者 矢花 剛 道都病院内科
【 要旨 】 現在,消化性潰瘍に対する治療戦略は,酸分泌抑制とHelicobacter pylori(H.pylori)除菌という二つの治療手段のうえに立って構築されているように思われる.H2受容体拮抗剤(H2-RA)がこのような戦略上,臨床医の期待に十分に応えうる薬剤であるかを,プロトンポンプ阻害剤(PPI)と比較しつつreviewした.また最近では,PPIの代わりにH2-RAを用いた,H.pylori除菌治療も各施設で試みられ,H.pylori除菌にはPPIが必須ではないともいわれ始めている.すべての潰瘍症例にPPIを投与することに異議を唱えるつもりはないが,わが国では胃潰瘍の大部分が低(正)酸を呈する胃角・体部潰瘍であることを考えると,ほとんどの胃潰瘍症例,とくに高位潰瘍ではH2-RAが第一選択薬であっても一向構わないと思う.
Theme Controversies in the Drug Therapy of Upper Gastrointestinal Tract Disorders
Title Should H2-RA be the Drug of Choice for Patients with Peptic Ulcers ?
Author Takeaki Kobayashi Department of Internal Medicine, Teine St.Luke's Hospital
Author Tsuyoshi Yahana Department of Internal Medicine, Doto Hospital
[ Summary ] Recently, a therapeutic strategy for treatment of peptic ulcer disease (PUD) appears to have been established on the following two essential bases. One is acid suppression, the another is eradication therapy for H.pylori (Hp) infection. Thus, in this review article, we examined whether H2 receptor antagonists (H2-RA) were sufficiently useful for PUD in clinical practice.
Recently, in addition, therapy for eradication of Hp along with H2-RA instead of proton pump inhibitor (PPI) has been extensively used in many institutions. The high eradication rate for Hp infections treated with a triple therapy, including H2-RA but not PPI, is considered to indicate that PPI alone is not necessarily indispensable to Hp eradication. Although we have no objections at this time to therapies using PPI for patients with PUD, it is thought to be suitable in clinical practice that H2-RA should be chosen first from the many anti-secretory drugs for gastric ulcer treatment, because the majority of gastric ulcers, in particular those located proximally to the stomach do not indicate high acid secretion.
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