Lederer P C, Lux G
Städtisches Krankenhaus Medizinische Klinik I, Solingen.
Z Gastroenterol. 1987 Aug;25 Suppl 3:175-80.
The outstanding success of H2-blocking agents in ulcer therapy proves gastric acid as a dominating factor in the pathogenesis of ulcers. Motility disturbances can be demonstrated in ulcer patients but up to now in therapeutic terms played only a minor role. The therapeutic success of the antimuscarinic drug pirenzepine which inhibits only gastric secretory volume without influencing gastric pH but exerting a significant influence on interdigestive motility of the upper gastrointestinal tract reestablishes this factor to be of pathogenetic relevance. The pathophysiological factor of motility disturbances in the etiology of gastric ulcers is stressed also by the results of a recent therapeutic study comparing ranitidine and cisapride, where the motility-stimulating benzamide showed exactly the same rate of success as the H2-blocker; this holds true for both healing rate and symptomatic improvement. Therefore as far as chronic gastric ulcer is concerned a combination therapy should be preferred thus avoiding the side-effects of a strong and long lasting suppression of gastric acid secretion.
H2受体阻断剂在溃疡治疗中取得的显著成功证明胃酸是溃疡发病机制中的主导因素。溃疡患者可出现运动功能紊乱，但迄今为止，从治疗角度来看，其作用较小。抗毒蕈碱药物哌仑西平仅抑制胃酸分泌量而不影响胃内pH值，但对上消化道消化间期运动有显著影响，其治疗成功再次证明该因素与发病机制相关。最近一项比较雷尼替丁和西沙必利的治疗研究结果也强调了胃溃疡病因中运动功能紊乱的病理生理因素，其中促动力苯甲酰胺的成功率与H2受体阻断剂完全相同；在愈合率和症状改善方面均如此。因此，就慢性胃溃疡而言，应首选联合治疗，从而避免强力且持久抑制胃酸分泌所带来的副作用。
