Dammann H G, Walter T A, Dreyer M, Dau B, Müller P, Simon B
Krankenhaus Bethanien, Hamburg, FRG.
Aliment Pharmacol Ther. 1987;1 Suppl 1:468S-492S. doi: 10.1111/j.1365-2036.1987.tb00657.x.
There are two major principles of ulcer therapy. Today, the most widely accepted drugs are those which substantially reduce aggressive factors (i.c. acid and pepsin), namely histamine H2-receptor antagonists, antimuscarinics and antacids. Less frequently applied are mucoprotective agents like colloidal bismuth compounds and sucralfate. Prostaglandins both reduce acid secretion substantially and are believed to enhance mucosal resistance. Their anti-ulcer efficacy, however, is solely explicable by their antisecretory activity. Although mucosa-strengthening agents and H2-receptor blockers have nearly identical healing rates, mucosa-strengthening agents have inconvenient dosage regimens (four times or twice daily) and are probably less effective in relieving pain. The same holds true for antacids. Prostaglandins, antimuscarinics and antacids have dose related side effects. In contrast, H2-receptor blockers are characterized by a clear mechanism of action, convenient dosage regimens, good tolerance and a low incidence of side-effects. H2-receptor antagonists are the most effective anti-ulcer drugs presently available.
溃疡治疗有两大主要原则。如今，应用最广泛的药物是那些能大幅降低攻击因子（即胃酸和胃蛋白酶）的药物，也就是组胺H2受体拮抗剂、抗胆碱能药物和抗酸剂。像胶体铋化合物和硫糖铝这样的黏膜保护剂应用较少。前列腺素既能大幅减少胃酸分泌，又被认为能增强黏膜抵抗力。然而，它们的抗溃疡疗效完全可由其抗分泌活性来解释。尽管黏膜强化剂和H2受体阻滞剂的愈合率几乎相同，但黏膜强化剂的给药方案不方便（每日四次或两次），而且在缓解疼痛方面可能效果较差。抗酸剂也是如此。前列腺素、抗胆碱能药物和抗酸剂都有剂量相关的副作用。相比之下，H2受体阻滞剂具有作用机制明确、给药方案方便、耐受性好且副作用发生率低的特点。H2受体拮抗剂是目前可用的最有效的抗溃疡药物。
