Geller L I, Bessonova G A
Klin Med (Mosk). 1992 Feb;70(2):85-8.
The investigations of 43 duodenal ulcer cases in the patients whose ulcers failed to cicatrize after a 8-week treatment with almagel and vicalin or cimetidine monotherapy revealed the role of the hereditary load, smoking intensity, initial ulcer dimensions, the presence of antral erosions and a pronounced periulcerous duodenitis in the phenomenon of slow healing duodenal ulcer. There was no statistical difference between the values of the basal and pentagastrin-stimulated levels of hydrochloric acid secretion in the morning, partial alkaline gastric secretion, gastrinemia, the rate of evacuation of the gastric contents into the duodenum, the outcome of pancreatic bicarbonates in the sample with exogenic secretin in those whose ulcers cicatrized after a 6-week therapy and those who failed to be cured after being exposed to the same therapy during 8 weeks. The production of hydrochloric acid in the evening and the incidence of manifest duodenal reflux were significantly higher in the patients with slowly healing ulcer. They also had a decreased sensitivity to the intraduodenal inflow of the hydrochloric acid that resulted in the increase of endogenic secretin (stimulating the production of pancreatic bicarbonates and their transport into the duodenum). In case the combination treatment with almagel and vicalin failed, the therapy with gastrocepin or sucralfate was employed. A supplementary course of sucralfate helped to reach a complete healing of noncomplicated ulcers even in the patients in whom the preceding cimetidine treatment failed.
对43例十二指肠溃疡患者进行了调查，这些患者在接受铝镁加和维加林或西咪替丁单一疗法治疗8周后溃疡未愈合。调查揭示了遗传负荷、吸烟强度、初始溃疡大小、胃窦糜烂的存在以及明显的溃疡周围十二指肠炎症在十二指肠溃疡愈合缓慢现象中的作用。在溃疡在6周治疗后愈合的患者和在8周相同治疗后未治愈的患者中，早晨基础胃酸分泌和五肽胃泌素刺激胃酸分泌的值、部分碱性胃分泌、胃泌素血症、胃内容物排入十二指肠的速率、外源性促胰液素刺激样本中胰腺碳酸氢盐的排出结果，均无统计学差异。溃疡愈合缓慢的患者夜间胃酸分泌和明显十二指肠反流的发生率显著更高。他们对十二指肠内盐酸流入的敏感性也降低，这导致内源性促胰液素增加（刺激胰腺碳酸氢盐的产生并将其转运至十二指肠）。如果铝镁加和维加林联合治疗失败，则采用胃复安或硫糖铝治疗。硫糖铝的补充疗程有助于使非复杂性溃疡完全愈合，即使在先前西咪替丁治疗失败的患者中也是如此。
