Bynum T E
Department of Medicine, Harvard Medical School, Boston, Massachusetts.
J Clin Gastroenterol. 1991;13 Suppl 2:S56-64.
The pathophysiology of gastric and duodenal ulcer disease has two sides: the aggressive attack, principally by the highly corrosive gastric acid; and the defending forces of mucus, mucosal resistance, and other protective substances and functions. This report reviews the roles of both the attacking and defending forces in the pathophysiology of ulcer disease. It also discusses how an early notion of ulcer formation (e.g., the Schwarz dictum of "no acid, no ulcer," first published in 1910) became the slogan by which ulcer disease was understood and from which therapy took its cue. Subsequent work has since found that the Schwarz dictum holds for duodenal ulcer, but not for gastric ulcer. Non-acid mechanisms of ulcer formation--i.e., impairment of at least one of the defending or protective forces--are also described, as are treatment approaches to ulcer disease. Although suppression of acid secretion is a mainstay of treatment, agents that safely and effectively strengthen the defense are being used more frequently. There are signs that the safe limits for acid-suppressing therapy have been reached or passed. On the other hand, the search for therapy that strengthens the defensive factors has only begun.
主要由高腐蚀性胃酸引发的侵袭性攻击；以及黏液、黏膜抵抗力和其他保护性物质及功能所构成的防御力量。本报告回顾了侵袭性攻击和防御力量在溃疡病病理生理学中的作用。它还讨论了溃疡形成的早期观念（例如，1910年首次发表的施瓦茨格言“无酸则无溃疡”）是如何成为理解溃疡病的口号以及治疗的线索来源的。后续研究发现，施瓦茨格言适用于十二指肠溃疡，但不适用于胃溃疡。文中还描述了溃疡形成的非酸性机制，即至少一种防御或保护力量的受损情况，以及溃疡病的治疗方法。尽管抑制胃酸分泌是治疗的主要手段，但能安全有效地增强防御能力的药物正被更频繁地使用。有迹象表明，抑酸治疗的安全限度已经达到或超过。另一方面，寻找增强防御因素的治疗方法才刚刚开始。
