Acid peptic diseases: pharmacological approach to treatment.
Acid peptic diseases: pharmacological approach to treatment.
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DOI：
10.1586/ecp.09.8
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发表时间：
2009-05
影响因子：
4.4
通讯作者：
Kraft WK
中科院分区：
文献类型：
--
作者：
Mejia A;Kraft WK
酸消化性疾病是独特的，但重叠的致病机制，导致过度的酸分泌或减少粘膜防御的结果。它们是日常临床实践中常见的实体，由于其慢性性，代表了医疗保健的重大成本。成功控制这些实体的关键因素是开发基于生理靶点的有效和安全的药物。组胺-2受体拮抗剂由于其安全性和有效性而彻底改变了酸性消化性疾病的治疗。质子泵抑制剂（PPIs）由于对酸分泌的更有效抑制而代表了进一步的治疗进展。来自临床试验和观察经验的充分数据证实了这些药物在治疗酸性消化性疾病中的效用，在药物类别之间和药物类别内具有不同的疗效和安全性特征。其作用速度和持续时间的范例强调了对新化学实体的需要，该化学实体从单剂量起将提供可靠的酸控制持续时间，特别是在夜间。此外，质子泵抑制剂可以降低但不能消除服用非甾体抗炎药的患者发生溃疡的风险，这反映了非靶向的生理病理途径以及维持胃内pH值超过4的能力的破坏。本文综述了目前对胃酸产生生理学的认识，讨论了针对胃酸产生的药物，并回顾了特定酸性消化性疾病的疗效，以及酸介导疾病治疗的当前挑战和未来方向。
Acid peptic disorders are the result of distinctive, but overlapping pathogenic mechanisms leading to either excessive acid secretion or diminished mucosal defense. They are common entities present in daily clinical practice that, owing to their chronicity, represent a significant cost to healthcare. Key elements in the success of controlling these entities have been the development of potent and safe drugs based on physiological targets. The histamine-2 receptor antagonists revolutionized the treatment of acid peptic disorders owing to their safety and efficacy profile. The proton-pump inhibitors (PPIs) represent a further therapeutic advance due to more potent inhibition of acid secretion. Ample data from clinical trials and observational experience have confirmed the utility of these agents in the treatment of acid peptic diseases, with differential efficacy and safety characteristics between and within drug classes. Paradigms in their speed and duration of action have underscored the need for new chemical entities that, from a single dose, would provide reliable duration of acid control, particularly at night. Moreover, PPIs reduce, but do not eliminate, the risk of ulcers in patients taking NSAIDs, reflecting untargeted physiopathologic pathways and a breach in the ability to sustain an intragastric pH of more than 4. This review provides an assessment of the current understanding of the physiology of acid production, a discussion of medications targeting gastric acid production and a review of efficacy in specific acid peptic diseases, as well as current challenges and future directions in the treatment of acid-mediated diseases.