今日の臨床サポート

消化不良

著者: 黒田浩一 亀田総合病院 感染症科

監修: 山中克郎 福島県立医科大学会津医療センター総合内科

著者校正/監修レビュー済:2018/04/02
患者向け説明資料

概要・推奨   

疾患のまとめ:
  1. 消化不良とは、心窩部の痛み、食後の膨満感、胸やけなどの上腹部症状のことである。ディスペプシアと記載されることが多い。
  1. 消化不良は、さまざまな病態から起こり、幅広い鑑別疾患を必要とする、多くの人が訴える症状である。有病率は25%程度とされるが、大多数の患者は医療機関を受診することはない。プライマリケア医を訪れる患者の2~5%が消化不良を訴える。
  1. RomeⅢ基準が2006年に発表され、食後の腹部膨満感、早期飽満感(early satiation)、心窩部の痛みまたは灼熱感、のいずれかに該当するものを「消化不良」と定義した。胸やけ症状は含んでいない。さらに2016年にRome IV基準が発表され定義がわずかに改定された。これらの基準は、研究用基準のため、臨床現場になじまない。実際の臨床現場では、1カ月以上続く心窩部痛を主体とした上部消化管症状を「消化不良」とすればよい。
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  1. 55歳以下で警告症状がない場合は、PPIの内服(4~8週間)、ピロリ菌の検査をして除菌を検討する。
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  1. 55歳以下で警告症状のない消化不良を訴える患者で、上部消化管内視鏡検査を行わずに経験的な酸分泌抑制薬の投与を行った場合、上部消化管悪性腫瘍の診断が遅れ予後が悪化する危険性は非常に低い。
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  1. 上部消化管悪性腫瘍・胃十二指腸潰瘍の検索のため、警告症状を聴取する。年齢が55歳以上、または警告症状がある場合は、早期の上部消化管内視鏡検査(GIF)の適応である。
  1. 警告症状:上部消化管の悪性腫瘍の家族歴、意図しない体重減少、上部消化管出血、進行性の嚥下障害、嚥下痛、説明できない鉄欠乏性貧血、持続する嘔吐、触知する腹部腫瘤・リンパ節、黄疸、上部消化管悪性腫瘍の既往歴、胃十二指腸潰瘍の既往歴。
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薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
黒田浩一 : 未申告[2021年]
監修:山中克郎 : 未申告[2021年]

病態・疫学・診察

疫学情報・病態・注意事項  
  1. 消化不良は、さまざまな病態から起こり、幅広い鑑別疾患を必要とする、多くの人が訴える症状である。有病率(prevalence)は25%程度とされる[1]が、大多数の患者は医療機関を受診することはない[2]。プライマリケア医を訪れる患者の2~5%が消化不良を訴える[3]
  1. 定義がさまざまであり混乱が生じやすい。慢性的な繰り返す上腹部の痛みと不快感(逆流症状が主な症状の場合は除く)、と定義してガイドライン[5][6]は作成されている(RomeⅡの定義)。ディスペプシアとカタカナで記載されることが多い。
  1. RomeⅢ基準が2006年に発表され、食後の腹部膨満感、早期飽満感(early satiation)、心窩部と痛みまたは灼熱感、のいずれかに該当するものを「消化不良(ディスペプシア)」と定義した[4]。胸焼け症状は含んでいない。食後のもたれ感・早期飽満感を有するものを食後愁訴症候群(postprandial distress syndrome、PDS)、心窩部痛・心窩部灼熱感を有するものを心窩部痛症候群(epigastric pain syndrome、EPS)と亜分類している。さらに2016年にRome IV基準が発表され定義がわずかに改定されたが、実際の診療の影響を与えるほどの変更点はなかった[12]。これらの基準は、研究用基準のため、臨床現場になじまない。実際の臨床現場では、1カ月以上続く心窩部痛を主体とした上部消化管症状を「消化不良」とすればよい[13]
  1. 原因疾患は、消化性潰瘍疾患15~25%、機能性ディスペプシア(FD)50~60%、胃食道逆流症(GERD)5~15%、悪性疾患(胃癌、食道癌)2%以下、の4疾患が重要である[2][5]。そのほか、過敏性腸症候群、胆道系由来の痛み、胃不全麻痺などが原因となることもある。胃癌・食道癌、胃十二指腸潰瘍をいかにしてみつけるかが重要となる。
問診・診察のポイント  
  1. 「消化不良」と判断する前に、上腹部症状が心疾患、腹壁の筋骨格系疾患、内分泌疾患由来でないか検討する。胸焼けや逆流症状が前面に出ている場合は、「消化不良」ではなくGERDと考えて、診療を進める。

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文献 

著者: N J Talley, A R Zinsmeister, C D Schleck, L J Melton
雑誌名: Gastroenterology. 1992 Apr;102(4 Pt 1):1259-68.
Abstract/Text It has been proposed that patients with dyspepsia can be classified into symptom groupings that may represent different pathophysiological entities; however, it remains to be shown that distinct symptom subgroups exist. To estimate the prevalence of dyspepsia (defined as upper abdominal pain) and dyspepsia subgroups, an age- and sex-stratified random sample of Olmsted County, Minnesota, residents, aged 30-64 years, were mailed a valid self-report questionnaire; 82% responded (n = 835). Subgroups were as follows: those with symptoms suggestive of peptic ulceration (ulcerlike dyspepsia), those with gastric stasis (dysmotilitylike dyspepsia), those with gastroesophageal reflux (refluxlike dyspepsia), and the remainder (unspecified dyspepsia). Ulcerlike dyspepsia was the commonest subgroup (prevalence, 16.0/100; 95% confidence interval, 13.4-18.5), but 43% of subjects with dyspepsia could be classified into more than one subgroup. Nearly one third of dyspeptics also had irritable bowel symptoms, but these were not confined to any particular dyspepsia subgroup. Although dyspepsia is very common in the community and the majority have ulcerlike symptoms, there is such overlap among the dyspepsia subgroups that a classification based on symptoms alone in uninvestigated patients may not be useful.

PMID 1551533  Gastroenterology. 1992 Apr;102(4 Pt 1):1259-68.
著者: O V Bazaldua, F D Schneider
雑誌名: Am Fam Physician. 1999 Oct 15;60(6):1773-84, 1787-8.
Abstract/Text Dyspepsia, often defined as chronic or recurrent discomfort centered in the upper abdomen, can be caused by a variety of conditions. Common etiologies include peptic ulcers and gastroesophageal reflux. Serious causes, such as gastric and pancreatic cancers, are rare but must also be considered. Symptoms of possible causes often overlap, which can make initial diagnosis difficult. In many patients, a definite cause is never established. The initial evaluation of patients with dyspepsia includes a thorough history and physical examination, with special attention given to elements that suggest the presence of serious disease. Endoscopy should be performed promptly in patients who have "alarm symptoms" such as melena or anorexia. Optimal management remains controversial in young patients who do not have alarm symptoms. Although management should be individualized, a cost-effective initial approach is to test for Helicobacter pylori and treat the infection if the test is positive. If the H. pylori test is negative, empiric therapy with a gastric acid suppressant or prokinetic agent is recommended. If symptoms persist or recur after six to eight weeks of empiric therapy, endoscopy should be performed.

PMID 10537391  Am Fam Physician. 1999 Oct 15;60(6):1773-84, 1787-8.
著者: R S Fisher, H P Parkman
雑誌名: N Engl J Med. 1998 Nov 5;339(19):1376-81. doi: 10.1056/NEJM199811053391907.
Abstract/Text
PMID 9801400  N Engl J Med. 1998 Nov 5;339(19):1376-81. doi: 10.1056/・・・
著者: Jan Tack, Nicholas J Talley, Michael Camilleri, Gerald Holtmann, Pinjin Hu, Juan-R Malagelada, Vincenzo Stanghellini
雑誌名: Gastroenterology. 2006 Apr;130(5):1466-79. doi: 10.1053/j.gastro.2005.11.059.
Abstract/Text A numerically important group of patients with functional gastrointestinal disorders have chronic symptoms that can be attributed to the gastroduodenal region. Based on the consensus opinion of an international panel of clinical investigators who reviewed the available evidence, a classification of the functional gastroduodenal disorders is proposed. Four categories of functional gastroduodenal disorders are distinguished. The first category, functional dyspepsia, groups patients with symptoms thought to originate from the gastroduodenal region, specifically epigastric pain or burning, postprandial fullness, or early satiation. Based on recent evidence and clinical experience, a subgroup classification is proposed for postprandial distress syndrome (early satiation or postprandial fullness) and epigastric pain syndrome (pain or burning in the epigastrium). The second category, belching disorders, comprises aerophagia (troublesome repetitive belching with observed excessive air swallowing) and unspecified belching (no evidence of excessive air swallowing). The third category, nausea and vomiting disorders, comprises chronic idiopathic nausea (frequent bothersome nausea without vomiting), functional vomiting (recurrent vomiting in the absence of self-induced vomiting, or underlying eating disorders, metabolic disorders, drug intake, or psychiatric or central nervous system disorders), and cyclic vomiting syndrome (stereotypical episodes of vomiting with vomiting-free intervals). The rumination syndrome is a fourth category of functional gastroduodenal disorder characterized by effortless regurgitation of recently ingested food into the mouth followed by rechewing and reswallowing or expulsion. The proposed classification requires further research and careful validation but the criteria should be of value for clinical practice; for epidemiological, pathophysiological, and clinical management studies; and for drug development.

PMID 16678560  Gastroenterology. 2006 Apr;130(5):1466-79. doi: 10.1053・・・
著者: Nicholas J Talley, Nimish B Vakil, Paul Moayyedi
雑誌名: Gastroenterology. 2005 Nov;129(5):1756-80. doi: 10.1053/j.gastro.2005.09.020.
Abstract/Text
PMID 16285971  Gastroenterology. 2005 Nov;129(5):1756-80. doi: 10.1053・・・
著者: Nicholas J Talley, Nimish Vakil, Practice Parameters Committee of the American College of Gastroenterology
雑誌名: Am J Gastroenterol. 2005 Oct;100(10):2324-37. doi: 10.1111/j.1572-0241.2005.00225.x.
Abstract/Text Dyspepsia is a chronic or recurrent pain or discomfort centered in the upper abdomen; patients with predominant or frequent (more than once a week) heartburn or acid regurgitation, should be considered to have gastroesophageal reflux disease (GERD) until proven otherwise. Dyspeptic patients over 55 yr of age, or those with alarm features should undergo prompt esophagogastroduodenoscopy (EGD). In all other patients, there are two approximately equivalent options: (i) test and treat for Helicobacter pylori (H. pylori) using a validated noninvasive test and a trial of acid suppression if eradication is successful but symptoms do not resolve or (ii) an empiric trial of acid suppression with a proton pump inhibitor (PPI) for 4-8 wk. The test-and-treat option is preferable in populations with a moderate to high prevalence of H. pylori infection (> or =10%); empirical PPI is an initial option in low prevalence situations. If initial acid suppression fails after 2-4 wk, it is reasonable to consider changing drug class or dosing. If the patient fails to respond or relapses rapidly on stopping antisecretory therapy, then the test-and-treat strategy is best applied before consideration of referral for EGD. Prokinetics are not currently recommended as first-line therapy for uninvestigated dyspepsia. EGD is not mandatory in those who remain symptomatic as the yield is low; the decision to endoscope or not must be based on clinical judgement. In patients who do respond to initial therapy, stop treatment after 4-8 wk; if symptoms recur, another course of the same treatment is justified. The management of functional dyspepsia is challenging when initial antisecretory therapy and H. pylori eradication fails. There are very limited data to support the use of low-dose tricyclic antidepressants or psychological treatments in functional dyspepsia.

PMID 16181387  Am J Gastroenterol. 2005 Oct;100(10):2324-37. doi: 10.1・・・
著者: A B R Thomson, A N Barkun, D Armstrong, N Chiba, R J White, S Daniels, S Escobedo, B Chakraborty, P Sinclair, S J O Veldhuyzen Van Zanten
雑誌名: Aliment Pharmacol Ther. 2003 Jun 15;17(12):1481-91.
Abstract/Text BACKGROUND: Uninvestigated dyspepsia is common in family practice. The prevalence of clinically significant upper gastrointestinal findings (CSFs) in adult uninvestigated dyspepsia patients, and their predictability based on history, is unknown.
METHODS: Prompt endoscopy was performed within 10 days of referral, in 1040 adult patients presenting with uninvestigated dyspepsia at 49 Canadian family practitioner centres. Subsequent management strategies during a 6-month follow-up period were determined by the individual family practitioners.
RESULTS: CSFs were identified in 58% (603/1040) of patients. Erosive oesophagitis was most common (43%; N = 451); peptic ulcer was uncommon (5.3%; N = 55). Alarm symptoms were uncommon (2.8%; N = 29). Most patients had at least three dyspepsia symptoms, more than 80% had at least six, and approximately half had eight or more. Based on the dominant symptom, 463 (45%) patients had ulcer-like, 393 (38%) had reflux-like and 184 (18%) had dysmotility-like dyspepsia. The patients' dominant symptom was not predictive of endoscopic findings. Oesophagitis was more common in those with dominant reflux-like symptoms and was the most common finding in all subgroups. The prevalence of gastroduodenal findings was similar in all symptom subgroups. Helicobacter pylori (H. pylori) infection (30%; 301/1013) was associated with gastroduodenal findings.
CONCLUSIONS: Dyspepsia subclassifications, based on dominant symptom, are of limited value in predicting the presence and nature of CSFs. Oesophagitis was by far the most common diagnosis (43% of patients). CSFs were common in uninvestigated dyspepsia patients and their nature suggests patients could be initially treated effectively, without endoscopy, using empirical acid suppressive therapy.

PMID 12823150  Aliment Pharmacol Ther. 2003 Jun 15;17(12):1481-91.
著者: R H Jones, G Baxter
雑誌名: Aliment Pharmacol Ther. 1997 Jun;11(3):541-6.
Abstract/Text AIM: To compare lansoprazole 30 mg daily with ranitidine 150 mg b.d. in the treatment of acid-related dyspepsia in general practice.
METHODS: In a double-blind, parallel group, randomized, mutlicentre study conducted in 32 general practices in the UK, 213 patients were randomized to receive lansoprazole 30 mg daily, and 219 to receive ranitidine 150 mg b.d., for 4 weeks. All patients had experienced symptoms of reflux-like or ulcer-like dyspepsia on at least 4 of the 7 days prior to the study; 75% had experienced dyspepsia in the past, and 74 of the lansoprazole patients and 77 of the ranitidine patients had documented histories of acid-related disorders, investigating by either radiology or endoscopy.
RESULTS: After 2 weeks 55% of the lansoprazole patients and 33% of the ranitidine group were symptom-free (P = 0.001, chi 2 = 7.12) with corresponding 4-week figures of 69% and 44%, respectively (P = 0.001, chi 2 = 18.03). Similar figures were found at both 2 and 4 weeks for daytime and night-time heartburn and epigastric pain scores; in the lansoprazole group, at 4 weeks, 80% of patients were free of daytime heartburn and 81% of night-time epigastric pain, compared with 55% (P = 0.001, chi 2 = 15.44) and 65% (P = 0.01, chi 2 = 6.10) in the ranitidine group.
CONCLUSION: Superior symptom relief for patients presenting with ulcer-like and reflux-like symptoms in general practice is provided by lansoprazole 30 mg daily compared with ranitidine 150 mg twice daily.

PMID 9218080  Aliment Pharmacol Ther. 1997 Jun;11(3):541-6.
著者: I Mason, L J Millar, R R Sheikh, W M Evans, P L Todd, M L Turbitt, M D Taylor
雑誌名: Aliment Pharmacol Ther. 1998 Mar;12(3):263-71.
Abstract/Text BACKGROUND: There is need for an evidence-based comparison of clinical management strategies to provide the rationale for selection of a particular therapeutic approach to treatment. Ideal dyspepsia treatment should quickly and conveniently alleviate patient symptoms whilst also minimizing the use of healthcare resources.
AIM: To examine dyspepsia symptom relief over 16 weeks and compare an omeprazole clinical management strategy with a commonly used combination of antacid-alginate followed by H2-antagonist.
METHODS: Seven hundred and twenty-five patients participated in this randomized, open, parallel group comparison over 16 weeks. Patients were randomized to receive either an omeprazole treatment strategy (363) consisting of omeprazole 10 mg stepping up to 20 mg and 40 mg as required, or an antacid-alginate/ranitidine treatment strategy (362) consisting of antacid-alginate 10 mL q.d.s. stepping up to ranitidine 150 mg b.d. and 150 mg q.d.s. as required.
RESULTS: A greater proportion of patients receiving the omeprazole clinical management strategy had achieved the stringent health target of complete symptom relief (61 vs. 40%, P < 0.0001) at 16 weeks. Forty-six per cent of omeprazole-treated patients were symptom free after the first 10 mg step compared to only 17% in the antacid-alginate treated group (P = 0.0001). Total relief of heartburn, the most common symptom at entry, was achieved by more patients in the omeprazole treatment group than the antacid-alginate/ranitidine treatment group, 62 vs. 36%, respectively, at 4 weeks, and 81 vs. 60% at 16 weeks (P = 0.0001).
CONCLUSION: Treatment with the omeprazole clinical management strategy was superior to the antacid-alginate/ranitidine management strategy in providing relief of acid-related dyspepsia symptoms after 16 weeks. In addition, the omeprazole treatment strategy involved fewer GP consultations and thus minimized the use of other healthcare resources.

PMID 9570261  Aliment Pharmacol Ther. 1998 Mar;12(3):263-71.
著者: Kenneth R DeVault, Donald O Castell, American College of Gastroenterology
雑誌名: Am J Gastroenterol. 2005 Jan;100(1):190-200. doi: 10.1111/j.1572-0241.2005.41217.x.
Abstract/Text Guidelines for the diagnosis and treatment of gastroesophageal reflux disease (GERD) were published in 1995 and updated in 1999. These and other guidelines undergo periodic review. Advances continue to be made in the area of GERD, leading us to review and revise previous guideline statements. GERD is defined as symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus. These guidelines were developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee, and approved by the Board of Trustees. Diagnostic guidelines address empiric therapy and the use of endoscopy, ambulatory reflux monitoring, and esophageal manometry in GERD. Treatment guidelines address the role of lifestyle changes, patient directed (OTC) therapy, acid suppression, promotility therapy, maintenance therapy, antireflux surgery, and endoscopic therapy in GERD. Finally, there is a discussion of the rare patient with refractory GERD and a list of areas in need of additional study.

PMID 15654800  Am J Gastroenterol. 2005 Jan;100(1):190-200. doi: 10.11・・・
著者: Vincenzo Stanghellini, Francis K L Chan, William L Hasler, Juan R Malagelada, Hidekazu Suzuki, Jan Tack, Nicholas J Talley
雑誌名: Gastroenterology. 2016 May;150(6):1380-92. doi: 10.1053/j.gastro.2016.02.011.
Abstract/Text Symptoms that can be attributed to the gastroduodenal region represent one of the main subgroups among functional gastrointestinal disorders. A slightly modified classification into the following 4 categories is proposed: (1) functional dyspepsia, characterized by 1 or more of the following: postprandial fullness, early satiation, epigastric pain, and epigastric burning, which are unexplained after a routine clinical evaluation; and includes 2 subcategories: postprandial distress syndrome that is characterized by meal-induced dyspeptic symptoms and epigastric pain syndrome that does not occur exclusively postprandially; the 2 subgroups can overlap; (2) belching disorders, defined as audible escapes of air from the esophagus or the stomach, are classified into 2 subcategories, depending on the origin of the refluxed gas as detected by intraluminal impedance measurement belching: gastric and supragastric belch; (3) nausea and vomiting disorders, which include 3 subcategories: chronic nausea and vomiting syndrome; cyclic vomiting syndrome; and cannabinoid hyperemesis syndrome; and (4) rumination syndrome.

Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.
PMID 27147122  Gastroenterology. 2016 May;150(6):1380-92. doi: 10.1053・・・
著者: Paul M Moayyedi, Brian E Lacy, Christopher N Andrews, Robert A Enns, Colin W Howden, Nimish Vakil
雑誌名: Am J Gastroenterol. 2017 Jul;112(7):988-1013. doi: 10.1038/ajg.2017.154. Epub 2017 Jun 20.
Abstract/Text We have updated both the American College of Gastroenterology (ACG) and the Canadian Association of Gastroenterology (CAG) guidelines on dyspepsia in a joint ACG/CAG dyspepsia guideline. We suggest that patients ≥60 years of age presenting with dyspepsia are investigated with upper gastrointestinal endoscopy to exclude organic pathology. This is a conditional recommendation and patients at higher risk of malignancy (such as spending their childhood in a high risk gastric cancer country or having a positive family history) could be offered an endoscopy at a younger age. Alarm features should not automatically precipitate endoscopy in younger patients but this should be considered on a case-by-case basis. We recommend patients <60 years of age have a non-invasive test Helicobacter pylori and treatment if positive. Those that are negative or do not respond to this approach should be given a trial of proton pump inhibitor (PPI) therapy. If these are ineffective tricyclic antidepressants (TCA) or prokinetic therapies can be tried. Patients that have an endoscopy where no pathology is found are defined as having functional dyspepsia (FD). H. pylori eradication should be offered in these patients if they are infected. We recommend PPI, TCA and prokinetic therapy (in that order) in those that fail therapy or are H. pylori negative. We do not recommend routine upper gastrointestinal (GI) motility testing but it may be useful in selected patients.

PMID 28631728  Am J Gastroenterol. 2017 Jul;112(7):988-1013. doi: 10.1・・・
著者: P Malfertheiner, F Megraud, C O'Morain, F Bazzoli, E El-Omar, D Graham, R Hunt, T Rokkas, N Vakil, E J Kuipers
雑誌名: Gut. 2007 Jun;56(6):772-81. doi: 10.1136/gut.2006.101634. Epub 2006 Dec 14.
Abstract/Text BACKGROUND: Guidelines on the management of Helicobacter pylori, which cover indications for management and treatment strategies, were produced in 2000.
AIMS: To update the guidelines at the European Helicobacter Study Group (EHSG) Third Maastricht Consensus Conference, with emphasis on the potential of H pylori eradication for the prevention of gastric cancer.
RESULTS: Eradication of H pylori infection is recommended in (a) patients with gastroduodenal diseases such as peptic ulcer disease and low grade gastric, mucosa associated lymphoid tissue (MALT) lymphoma; (b) patients with atrophic gastritis; (c) first degree relatives of patients with gastric cancer; (d) patients with unexplained iron deficiency anaemia; and (e) patients with chronic idiopathic thrombocytopenic purpura. Recurrent abdominal pain in children is not an indication for a "test and treat" strategy if other causes are excluded. Eradication of H pylori infection (a) does not cause gastro-oesophageal reflux disease (GORD) or exacerbate GORD, and (b) may prevent peptic ulcer in patients who are naïve users of non-steroidal anti-inflammatory drugs (NSAIDs). H pylori eradication is less effective than proton pump inhibitor (PPI) treatment in preventing ulcer recurrence in long term NSAID users. In primary care a test and treat strategy using a non-invasive test is recommended in adult patients with persistent dyspepsia under the age of 45. The urea breath test, stool antigen tests, and serological kits with a high accuracy are non-invasive tests which should be used for the diagnosis of H pylori infection. Triple therapy using a PPI with clarithromycin and amoxicillin or metronidazole given twice daily remains the recommended first choice treatment. Bismuth-containing quadruple therapy, if available, is also a first choice treatment option. Rescue treatment should be based on antimicrobial susceptibility.
CONCLUSION: The global burden of gastric cancer is considerable but varies geographically. Eradication of H pylori infection has the potential to reduce the risk of gastric cancer development.

PMID 17170018  Gut. 2007 Jun;56(6):772-81. doi: 10.1136/gut.2006.10163・・・
著者: Kouichi Sakurai, Akihito Nagahara, Kazuhiko Inoue, Junichi Akiyama, Katsuhiro Mabe, Junichi Suzuki, Yasuki Habu, Akihiro Araki, Tsuyoshi Suzuki, Katsuaki Satoh, Haruhiko Nagami, Ryosaku Harada, Nobuo Tano, Masayasu Kusaka, Yasuhiko Fujioka, Toshikatsu Fujimura, Nobuyuki Shigeto, Tsuneyo Oumi, Jun Miwa, Hiroto Miwa, Kazuma Fujimoto, Yoshikazu Kinoshita, Ken Haruma
雑誌名: BMC Gastroenterol. 2012 May 1;12:42. doi: 10.1186/1471-230X-12-42. Epub 2012 May 1.
Abstract/Text BACKGROUND: In Japan, treatment guidelines are lacking for patients with upper gastrointestinal symptoms. We aimed to compare the efficacy of different drugs for the treatment of uninvestigated upper gastrointestinal symptoms.
METHODS: This was a randomized, open-label, parallel-group multicenter study. Helicobacter pylori-negative, endoscopically uninvestigated patients ≥ 20 years of age with upper gastrointestinal symptoms of at least moderate severity (Global Overall Symptom score [GOS] ≥ 4 on a 7-point Likert scale) were randomized to treatment with omeprazole (10 mg once daily), famotidine (10 mg twice daily), mosapride (5 mg three times daily) or teprenone (50 mg three times daily). The primary endpoint was sufficient relief of upper gastrointestinal symptoms after 4 weeks of treatment (GOS ≤ 2). UMIN clinical trial registration number: UMIN000005399.
RESULTS: Of 471 randomized patients, 454 were included in the full analysis set. After 4 weeks of treatment, sufficient symptom relief was achieved by 66.9% of patients in the omeprazole group, compared with 41.0%, 36.3% and 32.3% in the famotidine, mosapride and teprenone groups, respectively (all, p < 0.001 vs omeprazole). There were no treatment-related adverse events.
CONCLUSIONS: The favorable efficacy and safety profiles of omeprazole in relieving uninvestigated upper gastrointestinal symptoms support its use as first-line treatment in this patient group in Japan. Patients who show no improvement in symptoms despite PPI use, and those with alarm symptoms (such as vomiting, GI bleeding or acute weight loss) should receive further investigation, including prompt referral for endoscopy.
TRIAL REGISTRATION: UMIN000005399.

PMID 22548767  BMC Gastroenterol. 2012 May 1;12:42. doi: 10.1186/1471-・・・

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