| 特集名 | 消化性潰瘍診療ガイドラインを臨床にどのように生かすか |
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| 題名 | 防御因子増強薬の果たす役割 -- ガイドラインを踏まえて |
| 発刊年月 | 2010年 12月 |
| 【 要旨 】 | 「消化性潰瘍診療ガイドライン」は，消化性潰瘍に関しては三つ目であり，徐々に改善されてきている．それは，日本人に関する成績が発表されてきたからである．欧米人と日本人の違いから，同じようなプロトコールで試験を行っても成績が異なる．その最たるものが，防御因子増強薬に関するエビデンスである．大きくは，除菌療法後の抗潰瘍治療としての防御因子増強薬の効果とNSAIDs潰瘍に対する防御因子増強薬の予防効果である．また，防御因子増強薬は，酸分泌抑制薬とは基本的に作用メカニズムが違うことより，今後，胃・十二指腸潰瘍だけではなく，酸とは無関係の小腸潰瘍もマネージメントしなければならない時代になった現在，その力を発揮する場ができたといえる． |
| Theme | Review of New Japanese Guideline for Peptic Ulcer Treatment |
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| Title | Role of Gastroprotective Drugs in Treatment and Prevention of Peptic Ulcers : Review of New Japanese Guidelines |
| [ Summary ] | We review the new Japanese Guidelines produced by the Japanese Society of Gastroenterology, and point out new evidence concerning gastroprotective drugs. Two interesting points are illustrated. One is gastric ulcer healing following Helicobacter pylori (H. pylori) eradication therapy. One week of H. pylori eradication therapy is insufficient to produce healing of gastric ulcers. There is strong evidence that proton pump inhibitors promote gastric ulcer healing following eradication therapy. However, it is unknown whether gastroprotective drugs are adequate to produce healing of ulcers after one week of eradication therapy. Rebamipide significantly promoted gastric ulcer healing following one week of eradication therapy, as compared to a placebo. Another factor is the prevention of non-steroidal antiinflammatory drug (NSAID) induced gastric ulcers. NSAIDs, including aspirin, are widely used for elderly patients. Administration of prostaglandin derivatives or PPIs has been proven to be effective for both prevention and treatment of gastric ulcers associated with NSAIDs. These drugs are recommended for treatment of NSAID-induced gastric ulcers in the Japanese guidelines. Rebamipide prevented NSAID-induced peptic ulcers as effectively as misoprostol in patients receiving long-term NSAID therapy. Rebamipide may be a useful therapeutic option for the prevention of NSAID-induced gastrointestinal ulcers because of its therapeutic effects and safety. Recent advances in diagnostic methods, including video capsule endoscopy and balloon endoscopy, have enabled us to examine the entire small intestine. We recognize that the prevalence of small intestinal damage in patients taking NSAIDs is high. Gastroprotective drugs may also be useful for minimal intestinal damage. |