Eight chronic atrophic gastritis are used for the thunder areas, and 90%of doctors have stepped on "thunder"!

For medical professionals for reading reference

Inventory of 8 unreasonable medication for chronic atrophic gastritis, you may have committed it.

Chronic atrophic gastritis is a type of chronic gastritis. It refers to a kind of chronic gastric gastric gastricization of gastric mucosal epithelium caused by repeated damage to the inherent glands, accompanied by or without intestinal glandularity disease. Treatment should be as targeted at the cause, follow the principle of individualization, to delay the progress of the lesion, reduce the risk of cancer, and improve the clinical symptoms of patients.

Reasonable medication is the key to the treatment of the disease, and chronic atrophic gastritis is commonly developed as a common clinical disease. During its treatment, if unreasonable medication occurs, it will affect the treatment of the disease.

This article passed a small test+8 prescription, how can we avoid chronic atrophic gastritis and unreasonable medication together!

Self -measurement questions (multiple choice questions)

Regarding the treatment of chronic atrophic gastritis, the following statement is correct:

A. Rebetzole sodium enteric -soluble tablets are suitable for patients with type A atrophic gastritis.

B. Patients with frequent ventricular period should not be applied to cotticin.

C. Eliminate pylori (HP) standard four -reciprocal therapy, 0.4g of metronidazole tablets, twice a day, orally after a meal.

D. Dopanolitone should not be used with Gaoxin.

E. Dopanolidone should not be used in combination with Craomycin.

Correct answer: B d E

Unreasonable medication 1:

Patients with Type A atrophic gastritis applied Rebitozole

内 Case: digestion of internal clinics, patients, female, 43 years old. Due to "3 months". Gastroscopy: Chronic atrophic gastritis (main part of the gastric body), HP detection negative.

型 Diagnosis: Type A atrophic gastritis.

▎ Prescription:

Rebitzole sodium enteric -soluble tablets 20mg, once a day, orally.

Analysis: Type A atrophic gastritis lesions are mainly found in the gastric body, which is diffuse distribution. The gastrointestinal mucosa is normal, serum wall cell antibody is positive, serum gastricin increases, gastric acid and endon factor secretion decrease or lack, and malignant is prone to occur. Anemia, also known as autoimmune gastritis. Type B atrophic gastritis lesions are more common in the gastricin, which are distributed in multiple stove, serum wall cell antibody negative, serum gastricin is normal, gastric acid secretion is normal or mild, non -malignant anemia, more prone to gastric cancer, this is this is A simple atrophic gastritis.

Rebitzole is a third -generation proton pump inhibitor, which can effectively inhibit gastric acid secretion, and gastric acid secretion of type A atrophic gastritis is reduced or lost. Therefore, the use of Rebitzole can not only achieve treatment purposes, but will aggravate the condition.

As an endogenous mucosa protective agent, Nipalone can improve the various defense capabilities of the mucosa, including increasing the secretion of gastric mucus, maintaining the normal structure and function of the mucus and hydrophobic layer, improved the level of amino glycogen in the gastric mucosa, and promoted The synthesis of endogenous prostaglandin increases gastric mucosal blood flow, promotes cell regeneration, maintains the dynamic balance of gastric mucosal cells, inhibits neutral granulocyte penetration, reduces oxidative damage, and has a significant effect on the treatment of chronic atrophic gastritis.

普 Suggestions: Use the narutone capsule (50 mg, 3 times a day, orally after meals) to replace the labrazole sodium enteric soluble tablets.

Unreasonable medication 2:

Patients with frequent ventricular pre -phase contraction patients apply craticin

内 Case: digestion of internal clinics, patients, male, 51 years old. Due to "poor natal, 5 months of abdominal pain". In the past, there was a history of "coronary heart disease, frequent interfinement pre -contraction" medical history for 4 years. There is no history of allergies. Gastroscopy: Chronic atrophic gastritis (mainly gastric sinus), HP test positive.

Diagnosis: ① Chronic atrophic gastritis, HP infection; ② Coronary heart disease, frequent ventricular prefabreal.

▎ Prescription:

Omeprazole enteric -soluble tablets 20mg, twice a day, orally half an hour before meal; 220mg of citrate potassium granules, 2 times a day, orally before the meal; 1g of Amoxicin capsules, 2 times a day, after a meal, after a meal, after a meal, after a meal, after a meal, after a meal Oral; 0.5g of cordicillin tablets, twice a day, orally after a meal. The course of treatment is 14 days.

染 Analysis: HP infection is the most common cause of chronic atrophic gastritis. The inflammation and immune response caused by long -term HP infection can cause some patients to cause gastric mucosa atrophy and intestinal epithelium. The Fifth National Helicobacter Pyrobiotic Infection Treatment Consensus Report "uses chronic gastritis with gastric mucosa atrophy and erosion as a recommended disease that eliminates HP. Partial atrophy is reversed.

"Opinions of China Chronic Gastritis Consensus (2017)" also requires chronic gastritis that proves HP positive, regardless of whether there are symptoms and complications, unless there are competing factors. According to my country's HP consensus opinion, it is recommended for the four -reciprocal therapy for proton pump inhibitors+pyrine+2 antibacterial drugs. Proton pump inhibitors can be used in any type of omeprazole, Rebitzole, osteoprazole, Ameprazole, Lanzozole, and Apoliprazole. Recommended agent is recommended to use potassium citrate or colloidal gels. The antibacterial drugs recommended by the front line are amoxicillin, craticin or metronidazole.

Craithromycin can cause the QT period to extend, and may cause cutting -edge torsional ventricular speed, even ventricular fibrillation or sudden death. Although it is rare, it is death. Therefore, patients with basic arrhythmias, abnormal heartbeats, extension of Q-T period, ischemic heart disease, and congestive heart failure are disabled for disable craticin. In this example, patients with coronary heart disease and frequent interfinement are used to contrast patients, and caromycin should not be applied.

Metronidazole does not have similar adverse reactions.

硝 Suggestions: Use metronidazole tablets (0.4g, 3 to 4 times a day, orally after meals) to replace cordicillin tablets. Unreasonable medication 3:

Small dose of potassium citrate and amoxicillin

内 Case: digestion of internal clinics, patients, female, 39 years old. Due to the "poor natal and upper abdominal pain for 6 months". Previous health, no history of drug allergies. Gastroscopy: Chronic atrophic gastritis (mainly gastric sinus), HP test positive.

性 Diagnosis: chronic atrophic gastritis, HP infection.

▎ Prescription:

奥美拉唑肠溶片20mg，1日2次，餐前半小时口服；枸橼酸铋钾颗粒110mg，1日2次，餐前半小时口服；阿莫西林胶囊0.5g，1日2次，餐Out of oralness; 0.5g of cordicillin tablets, twice a day, orally after a meal.

P Analysis: eradicate HP standard four -reciprocal therapy, Omeprazole entero -soluble tablets 20 mg, twice a day, orally half an hour before meal; 220 mg of potassium pamperin particles, 2 times a day, orally before meals; amoxicillin; amuspicious; Capsule 1g, twice a day, orally after a meal; cordycin tablets 0.5g, twice a day, orally after a meal. The treatment is 10 to 14 days.

This example is used in the dose of potassium citrate potassium citrate and amoxicillin capsules, which can easily lead to eliminating HP failure.

橼 Suggestions: more correct citrate potassium granules and amoxicillin capsules.

Unreasonable medication 4:

Metronidazole is less frequent

内 Case: digestion of internal clinics, patients, male, 57 years old. Due to "upper abdominal pain and five months". Previous health, no history of drug allergies. Gastroscopy: Chronic atrophic gastritis (mainly gastric sinus), HP test positive.

性 Diagnosis: chronic atrophic gastritis, HP infection.

▎ Prescription:

Omeprazole enteric -soluble tablets 20mg, twice a day, orally half an hour before meal; 220mg of citrate potassium granules, 2 times a day, orally before the meal; 1g of Amoxicin capsules, 2 times a day, after a meal, after a meal, after a meal, after a meal, after a meal, after a meal Oral; 0.4g of metronidazole tablets, twice a day, orally after a meal.

P Analysis: Eliminate HP standard four -combined therapy, 0.4g of metronidazole tablets, 3 to 4 times a day, orally after a meal. In this case, the number of metronidazole is small, which can easily lead to HP resistance or recurrence.

Suggestion: The number of metronidazole tablets is corrected from 3 to 4 times a day.

Unreasonable medication 5:

Moshabeli after meals and oral meals

内 Case: digestion of internal clinics, patients, male, 56 years old. Due to "3 months of upper abdomen". Previous health, no history of drug allergies. Gastroscopy: Chronic atrophic gastritis (mainly gastric sinus), HP detection negative.

性 Diagnosis: Chronic atrophic gastritis.

▎ Prescription:

Moshari tablets 5mg, 3 times a day, orally after a meal.

肠 Analysis: Gastrointestinal dynamic medicine (except for Qumei Pudding, Puka Bipyl) 15-30 minutes before meals orally, because the medicine is affected by small food and absorbed, and the drug can reach the blood peak after the meal. Concentration, better play.

橼 Suggestion: The usage of more citrus citrus preaming is orally before the meal.

Unreasonable medication 6:

Insucting HP treatment insufficient treatment

内 Case: digestion of internal clinics, patients, female, 35 years old. Due to "upper abdominal pain and 6 months". Previous health, no history of drug allergies. Gastroscopy: Chronic atrophic gastritis (mainly gastric sinus), HP test positive.

性 Diagnosis: chronic atrophic gastritis, HP infection.

▎ Prescription:

Omeprazole enteric -soluble tablets 20mg, twice a day, orally half an hour before meal; 220mg of citrate potassium granules, 2 times a day, orally before the meal; 1g of Amoxicin capsules, 2 times a day, after a meal, after a meal, after a meal, after a meal, after a meal, after a meal Oral; 0.5g of cordicillin tablets, twice a day, orally after a meal. The course of treatment is 7 days.

P Analysis: Elimination of HP Standard Four -Division therapy (铋 agent+proton pump inhibitor+2 antibiotics) 10 days or 14 days is the first main plan recommended by consensus in my country, and the 14 -day plan should be adopted as much as possible. The 14 -day HP eradication rate is higher than those who are 10 days. The course of treatment is sufficient, which can not only increase the HP root periodic rate, but also reduce HP anti -bacterial drugs to produce drug resistance.

This case is insufficient for HP treatment, which can easily lead to the failure of HP.

P Suggestions: Eliminate the treatment of HP standard four -recovery treatment for 10 to 14 days.

Unreasonable medication 7:

Panpanlone is used in combination with Di Gaoxin

内 Case: digestion of internal clinics, female, 44 years old. Due to "3 weeks of upper abdomen". In the past, there was a history of "coronary heart disease and chronic heart failure" for 2 years. Gastroscopy: Chronic atrophic gastritis (mainly gastric sinus), HP detection negative.

Diagnosis: ① Chronic atrophic gastritis; ② Coronary heart disease, chronic heart failure, heart function III.

▎ Prescription:

Dorpone tablets are 10mg, 3 times a day, and orally 30 minutes before the meal.

能 Analysis: Gaoxin can effectively treat positive muscle medicine for chronic heart failure, and its clinical application is widely used. However, the safety range of the high -quality high -level is narrow, the amount of treatment is close to the amount of poisoning, and the individual differences are large.

Dopanolidone is a peripheral dopamine receptor antagonist, which can promote gastrointestinal peristalsis and tension to restore normal, promote gastric emptying, increase gastric sinus and duodenal exercise, and reduce the absorption of Gaoxin on the upper end of the small intestine.

The combination of Danparone and the Gaoxin, which reduces the concentration of high -gallophyte blood, and weakens the effect of strong heart, which can cause patients to increase heart failure.

Gastrointestinal dynamic drugs (metharocoprides, Mosimer, Etoly) are used with similar interactions with ground Gaoxin.地 Suggestions: Adjustable Gaoxin tablets administration time: 10mg of Danpanoline tablets, 3 times a day, orally 30 minutes before the meal; 0.25mg of Gaoxin tablets, once a day, orally at about 9 o'clock in the evening.

Unreasonable medication 8:

Dippanolidone and claxycin are used in combination

内 Case: digestion of internal clinics, patients, male, 68 years old. Due to "7 months of upper abdomen". Previous health, no history of drug allergies. Gastroscopy: Chronic atrophic gastritis (mainly gastric sinus), HP test positive.

性 Diagnosis: chronic atrophic gastritis, HP infection.

▎ Prescription:

Doramone tablets are 10mg, 3 times a day, orally half an hour before meal; omeprazole enteropolic tablets 20 mg, 2 times a day, orally half an hour before meal; 220mg of citrate potassium granules ; Amoxicin capsules 1g, twice on the 1st, orally after meals; cordicillin tablets 0.5g, twice a day, orally after meals. The course of treatment is 14 days.

酮 Analysis: Dopanlzone is mainly metabolized by CYP3A4, which can cause the ECG Q-T inter-interval period. Significant inhibitory CYP3A4 enzymes and drugs that may cause extension of Q-T inter-inter-periodic periods such as ketoconazole, fluorogatzole, voltamazole, erythromycin, craticin, and amine iodone, and it will increase the incidence of cutting-edge tires. Quick risk, banned with the above drugs.

There is no similar interaction between Malay sour curge and craticin.

Suggestions: Doradone tablets should not be used in combination with craticin tablets. It can be used to use Malay acidic curd tablets (0.1g, 3 times a day, orally) to replace Dopanlltone tablets.

The main points of chronic atrophic gastritis rational medication

Patients with type A atrophic gastritis should not apply proton pump inhibitors.

Patients with frequent ventricular duration should not be applied to cordycin.

Eliminate the HP standard four -combined therapy, 220 mg of potassium porridge particles per time, 1g of amoxicillin capsules each time, metronidazole tablets 3 to 4 times a day, and the course of treatment is 10 to 14 days.

The gastrointestinal dynamic medicine (except for Qume pudding, Puka Bipye) 15-30 minutes before the meal.

Dopanlidone should not be used in combination with Gauchromy and Claithromycin.

references:

[1] The National Health and Health Commission of the People's Republic of China. Principles of the clinical application guidance of proton pump inhibitors (2020) [J]. China Practical Rural Doctor Magazine, 2021, 28 (1): 1-9.

[2] The Pharmaceutical Professional Committee of the Chinese Pharmaceutical Society, the Chinese Medical Association Clinical Pharmaceutical Branch, the Proton Pump inhibitors Optimized Application Expert Consensus. " (21): 2195-2213.

[3] The Chinese Medical Association, the Chinese Medical Association Magazine, the Chinese Medical Association Gastroenterology Branch, etc. -775.

[4] The Chinese Medical Association, the Chinese Medical Association Magazine, the Chinese Medical Association Gastroenterology Branch, etc. : 776-780.

[5] Chinese Medical Association Gastrointestinal Society. China Chronic Gastritis Consensus Opinions (2017, Shanghai) [J]. Gastrointestinal disease, 2017, 22 (11): 670-678.

[6] Li Mei. Research and analysis of the problems of unreasonable medication in the Department of Gastroenterology [J]. China continues to medical education, 2020, 12 (4): 119-121.

[7] Wang Yuwei. Analysis of unreasonable medication problems in the Department of Gastroenterology [J]. China Health Industry, 2020, 17 (8): 52-54.

[8] Zhang Zhonghong, Qin Yun. Discussion on the clinical unreasonable drugs of digestive medicine [J]. The world's latest medical information excerpts, 2019, 19 (57): 188, 193.

[9] Qian Huanhuan, Cui Lihong. The mechanism and clinical application progress of tadarone [J]. Gastrointestinal disease and liver disease magazine, 2017, 26 (1): 100-103.

The first release in this article: The digestive liver disease channel in the medical community

Author of this article: Ge Jinhua

Review of this article: Deputy Chief Physician of the Second People's Hospital of Jingdezhen City, Yang Health

Editor in charge: xu

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