The Evolution of Peptic Ulcer Therapy
The Evolution of Peptic Ulcer Therapy
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消化性溃疡治疗的演变
DOI：
10.1111/j.1749-6632.1991.tb27268.x
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发表时间：
1991
影响因子：
5.2
通讯作者：
R. Mcisaac
中科院分区：
文献类型：
--
作者：
C. Warner;R. Mcisaac
酸性消化性疾病的治疗涉及一系列控制胃酸分泌的尝试，以治愈和预防十二指肠溃疡的复发。早期治疗试图通过饮食调整、Sippy饮食和Doll's milk drip中和胃酸来治愈。就在世纪之交之前，外科医生开始进行胃切除术。1943年，Lester Dragstedt医生进行了第一次迷走神经干切断术，以限制胃酸分泌的胆碱能刺激。这导致了胃切除术与迷走神经切断术相结合的手术。1970年，第一例壁细胞迷走神经切断术被实施。这种显微外科技术限制了迷走神经引起的胃酸分泌，同时最大限度地减少了对其他胃肠道功能的影响。到20世纪60年代，药物干预包括抗酸剂以中和酸和抗胆碱能药物以减少酸的产生量。这些治疗方法的有效性各不相同，其中一些会引起严重的副作用。1976年，随着第一种H2受体拮抗剂西咪替丁的引入，酸性消化性疾病的治疗开始了一个新的阶段。雷尼替丁，第二H2受体拮抗剂，产生更大的酸抑制在早晨和晚上与bid剂量比西咪替丁与quid剂量。认识到酸的产生有昼夜节律模式，在晚上10点到凌晨2点之间水平较高，导致了雷尼替丁单次晚间剂量的开发和使用。正在进行的研究继续调查剂量时机的影响和更有效的抑酸剂的影响。最后，讨论了维持治疗和胃酸分泌的问题。雷尼替丁在预防溃疡复发方面优于西咪替丁的临床优势可归因于其对夜间抑酸的控制。
The treatment of acid peptic disease has involved a series of attempts to control gastric acid secretion in order to heal and to prevent recurrence of duodenal ulcers. Early treatment attempted to heal by neutralizing gastric acid with diet modification, the Sippy diet, and Doll's milk drip. Just before the turn of the century, surgeons began performing gastric resections. In 1943, Dr. Lester Dragstedt performed the first truncal vagotomy to limit cholinergic stimulation of gastric acid secretion. This led to surgery that combined gastric resections with vagotomy. In 1970, the first parietal cell vagotomy was performed. This microsurgical technique limited vagal initiation of acid secretion while minimizing the impact on other gastrointestinal functions. By the 1960s, pharmacological intervention included antacids to neutralize acid and anticholinergics to reduce the amount of acid produced. These treatments varied in their effectiveness, and some of them caused significant side effects. In 1976, treatment of acid peptic disease began a new phase with the introduction of the first H2 receptor antagonist, cimetidine. Ranitidine, the second H2 receptor antagonist, produced greater acid suppression in the morning and at night with bid dosing than cimetidine with quid dosing. The knowledge that there is a circadian pattern in acid production, with higher levels between 10 PM and 2 AM, resulted in the development and use of a single evening dose of ranitidine. Ongoing research continues to investigate the effects of dose timing and the influence of more potent acid-suppressing agents. Finally, the issue of maintenance therapy and gastric acid secretion was addressed. The clinical advantage that ranitidine has over cimetidine in the prevention of ulcer recurrence can be attributed to its control of nocturnal acid suppression.
大鼠生物素肠道运输的个体发生。
影响因子：
29.4
作者：
Said,HM;Redah,R
通讯作者：
Redah,R