Texter E C
University of Arkansas for Medical Sciences, Little Rock 72205.
Scand J Gastroenterol Suppl. 1987;134:1-20. doi: 10.3109/00365528709090135.
Pain is commonly the initial symptom in peptic ulcer, but the mechanism is controversial. Chemical irritation by hydrochloric acid (HCl) and disordered motor activity have been implicated. Questions have been raised as to whether pain is a good indicator of an active ulcer. We have studied the mechanism of ulcer pain, using intragastric administration of 0.1 N HCl, study of X-ray alterations, measurement of intraluminal pressures, and measurement of gastric acidity along with fluorocinematography. Ulcer pain was accompanied by a synchronous increase in motor activity; gastric emptying was rapid with duodenal ulcer and delayed with gastric ulcer; relief of pain occurred with emptying. Ulcer pain is not a good indicator of activity. Relief of ulcer pain before endoscopic healing with famotidine is due to the inhibition of HCl below the threshold required to initiate disturbances of motor activity. Recurrent 'silent' ulcer with complications occurs in 40% of patients.
疼痛通常是消化性溃疡的初始症状，但其机制存在争议。盐酸（HCl）的化学刺激和运动活动紊乱被认为与之有关。对于疼痛是否是活动性溃疡的良好指标也存在疑问。我们通过胃内给予0.1N HCl、研究X线改变、测量腔内压力以及测量胃酸并结合荧光电影摄影术来研究溃疡疼痛的机制。溃疡疼痛伴随着运动活动的同步增加；十二指肠溃疡时胃排空迅速，胃溃疡时胃排空延迟；疼痛随着排空而缓解。溃疡疼痛不是活动性的良好指标。在用法莫替丁进行内镜愈合之前溃疡疼痛的缓解是由于将HCl抑制到引发运动活动紊乱所需阈值以下。40%的患者会出现伴有并发症的复发性“无症状”溃疡。
