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Abstract：
The Japanese Society of Gastroenterology (JSGE) revised the third edition of evidence-based clinical practice guidelines for peptic ulcer disease in 2020 and created an English version. The revised guidelines consist of nine items: epidemiology, hemorrhagic gastric and duodenal ulcers, Helicobacter pylori (H. pylori) eradication therapy, non-eradication therapy, drug-induced ulcers, non-H. pylori, and nonsteroidal anti-inflammatory drug (NSAID) ulcers, remnant gastric ulcers, surgical treatment, and conservative therapy for perforation and stenosis. Therapeutic algorithms for the treatment of peptic ulcers differ based on ulcer complications. In patients with NSAID-induced ulcers, NSAIDs are discontinued and anti-ulcer therapy is administered. If NSAIDs cannot be discontinued, the ulcer is treated with proton pump inhibitors (PPIs). Vonoprazan (VPZ) with antibiotics is recommended as the first-line treatment for H. pylori eradication, and PPIs or VPZ with antibiotics is recommended as a second-line therapy. Patients who do not use NSAIDs and are H. pylori negative are considered to have idiopathic peptic ulcers. Algorithms for the prevention of NSAID- and low-dose aspirin (LDA)-related ulcers are presented in this guideline. These algorithms differ based on the concomitant use of LDA or NSAIDs and ulcer history or hemorrhagic ulcer history. In patients with a history of ulcers receiving NSAID therapy, PPIs with or without celecoxib are recommended and the administration of VPZ is suggested for the prevention of ulcer recurrence. In patients with a history of ulcers receiving LDA therapy, PPIs or VPZ are recommended and the administration of a histamine 2-receptor antagonist is suggested for the prevention of ulcer recurrence.
摘要：
日本胃肠病学会（JSGE）于2020年修订了第三版《消化性溃疡循证临床实践指南》，并创建了英文版。修订后的指南包括九个项目：流行病学，出血性胃溃疡和十二指肠溃疡,幽门螺杆菌(H.幽门螺杆菌)根除治疗，非根除疗法，药物引起的溃疡，非H.pylori,和非甾体抗炎药（NSAID）溃疡，残余胃溃疡，手术治疗,穿孔和狭窄的保守治疗。用于治疗消化性溃疡的治疗算法基于溃疡并发症而不同。在NSAID引起的溃疡患者中，停用NSAIDs并给予抗溃疡治疗。如果NSAIDs不能停用，溃疡用质子泵抑制剂(PPI)治疗.使用抗生素的沃诺拉赞（VPZ）被推荐作为根除幽门螺杆菌的一线治疗，和PPI或VPZ与抗生素被推荐作为二线治疗。不使用NSAIDs且幽门螺杆菌阴性的患者被认为患有特发性消化性溃疡。本指南介绍了预防NSAID和低剂量阿司匹林（LDA）相关溃疡的算法。这些算法基于LDA或NSAIDs的伴随使用以及溃疡史或出血性溃疡史而有所不同。在接受NSAID治疗的有溃疡史的患者中，建议使用或不使用塞来昔布的PPI，建议使用VPZ预防溃疡复发。在接受LDA治疗的有溃疡史的患者中，建议使用PPI或VPZ，并建议使用组胺2受体拮抗剂预防溃疡复发。
