University of Western Sydney, Sydney, Australia.
J Gastroenterol Hepatol. 2011 Jan;26 Suppl 1:35-41. doi: 10.1111/j.1440-1746.2010.06537.x.
The search for the cause or causes of peptic ulcers has been a long one. It was recognised as early as the 19th Century that damage to the stomach or duodenal bulb was likely to result if the resistance of their mucosae to luminal acid was for some reason impaired. An early theory suggested microscopic vascular occlusion leading to local infarction could be the initiating event but evidence was lacking. Excessive acid secretion is seen in some patients but not in many so is implausible as the main factor in most ulcers. Cigarette smoking is a risk factor and chronic life difficulties has been shown to sometimes play a part, but we would now think that they play only minor roles to possibly tip the balance when a major etiologic factor is already present. The overwhelming evidence now is that the major etiologic factors in chronic peptic ulcer are ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs) and infection with Helicobacter pylori. Understanding the mechanism of the first, and the discovery and demonstration of Koch's postulates for the second, have been instrumental in the award of two Nobel prizes.
寻找消化性溃疡的病因由来已久。早在 19 世纪，人们就认识到，如果胃或十二指肠黏膜的抵抗腔酸性的能力由于某种原因受损，就有可能导致损伤。早期的理论认为，导致局部梗死的微小血管阻塞可能是起始事件，但缺乏证据。在一些患者中可以看到胃酸分泌过多，但在许多患者中并非如此，因此在大多数溃疡中，胃酸分泌过多不太可能是主要因素。吸烟是一个危险因素，慢性生活困难有时也会起作用，但我们现在认为，当主要病因已经存在时，它们只可能起到次要作用，以改变平衡。现在的压倒性证据表明，慢性消化性溃疡的主要病因是摄入非甾体抗炎药（NSAIDs）和感染幽门螺杆菌。对第一个病因的机制的理解，以及对第二个病因的科赫假设的发现和证明，对获得两项诺贝尔奖起到了重要作用。
