Chiverton S G, Hunt R H
Division of Gastroenterology, McMaster University Medical Center, Ontario, Canada.
Scand J Gastroenterol Suppl. 1989;166:43-7; discussion 74-5. doi: 10.3109/00365528909091243.
Although current concepts of ulcer pathophysiology postulate an imbalance between the principal aggressive factors of acid and pepsin and an impairment of mucosal defence, effective acid reduction by a variety of antisecretory drugs is associated with a significant acceleration of duodenal and gastric ulcer healing in controlled clinical trials. The healing of duodenal ulcer is related to the degree and duration of acid reduction with currently available H2-receptor antagonists. The highly significant correlation between the reduction of nocturnal acidity and ulcer healing reflects the ability of these drugs to inhibit basal and nocturnal acid secretion to a greater extent than stimulated daytime secretion. The extent to which the addition of daytime acid inhibition to that of nocturnal acid inhibition is responsible for further accelerating ulcer healing has not yet been determined, although a model has been proposed recently to explore this effect. Omeprazole has a marked effect on the duration and the degree of inhibition of intragastric acidity which is dose-dependent. In clinical trials of duodenal ulcer treatment, this efficacy and duration of effect is associated with an increased rate of healing and a leftward shift of the healing time curve.
尽管目前关于溃疡病理生理学的概念假定胃酸和胃蛋白酶等主要攻击因子与黏膜防御受损之间存在失衡，但在对照临床试验中，多种抑酸药物有效降低胃酸与十二指肠溃疡和胃溃疡愈合的显著加速相关。十二指肠溃疡的愈合与目前可用的H2受体拮抗剂降低胃酸的程度和持续时间有关。夜间胃酸降低与溃疡愈合之间的高度显著相关性反映了这些药物抑制基础和夜间胃酸分泌的能力比刺激的白天分泌更强。尽管最近提出了一个模型来探讨这种效应，但在夜间胃酸抑制的基础上增加白天胃酸抑制在多大程度上有助于进一步加速溃疡愈合尚未确定。奥美拉唑对胃内酸度抑制的持续时间和程度有显著影响，且呈剂量依赖性。在十二指肠溃疡治疗的临床试验中，这种疗效和作用持续时间与愈合率增加及愈合时间曲线左移有关。
