Begg Maha, Tarhuni Mawada, N Fotso Monique, Gonzalez Natalie A, Sanivarapu Raghavendra R, Osman Usama, Latha Kumar Abishek, Sadagopan Aishwarya, Mahmoud Anas, Khan Safeera
Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfiled, USA.
Cureus. 2023 Aug 29;15(8):e44341. doi: 10.7759/cureus.44341. eCollection 2023 Aug.
Peptic ulcer disease (PUD) refers to the occurrence of an open erosion in the inner lining of the stomach, duodenum, or sometimes lower esophagus. Treatments like proton pump inhibitors (PPIs) or histamine 2 receptor antagonists (H2RAs) are available on the market to efficiently treat the break in the mucosal lining. However, there is little evidence about the effects of the medication on the type and location of the ulcer and the epigastric pain caused by disintegration and increased acidity in the stomach. Given the above, we conducted a systematic review comparing the safety and efficacy of PPIs and H2RAs in various ulcer locations (gastric, duodenal, and pre-pyloric) and the effect of prolonging the treatment with the same medication or changing into a drug from another class in treatment-resistant ulcers. We employed major research literature databases and search engines such as PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Science Direct, and Google Scholar to find relevant articles. After a thorough screening, a quality check using various tools, and applying filters that suited our eligibility criteria, we identified eight articles, of which five were random clinical trials (RCTs), two review articles, and one meta-analysis. This study compares the different side effects of PPIs and H2RAs. Most studies concluded that omeprazole is superior in healing ulcers and bringing pain relief and that patients resistant to H2RAs can be treated better when switched to a PPI. This study also discusses the adverse effects of chronic use, such as diarrhea, constipation, headaches, and gastrointestinal infections. Patients on long-term PPI therapy are required to take calcium supplements to prevent the risk of fractures in older adults. Regarding long-term outcomes, PPIs remain the mainstay of treatment for peptic ulcer disease, based on the papers we reviewed.
消化性溃疡病（PUD）是指胃、十二指肠或有时是食管下段的内层出现开放性糜烂。市场上有质子泵抑制剂（PPI）或组胺2受体拮抗剂（H2RA）等治疗方法可有效治疗黏膜内衬的破损。然而，关于药物对溃疡类型、位置以及胃内酸度增加和糜烂引起的上腹部疼痛的影响，证据很少。鉴于上述情况，我们进行了一项系统评价，比较PPI和H2RA在不同溃疡部位（胃、十二指肠和幽门前）的安全性和有效性，以及在难治性溃疡中延长使用同一药物治疗或换用另一类药物的效果。我们利用主要的研究文献数据库和搜索引擎，如PubMed、医学文献分析和联机检索系统（MEDLINE）、科学Direct和谷歌学术搜索来查找相关文章。经过全面筛选、使用各种工具进行质量检查以及应用符合我们纳入标准的筛选条件后，我们确定了8篇文章，其中5篇是随机临床试验（RCT），2篇综述文章，1篇荟萃分析。本研究比较了PPI和H2RA的不同副作用。大多数研究得出结论，奥美拉唑在溃疡愈合和缓解疼痛方面更具优势，对H2RA耐药的患者换用PPI治疗效果更好。本研究还讨论了长期使用的不良反应, 如腹泻、便秘、头痛和胃肠道感染。长期接受PPI治疗的患者需要补充钙以预防老年人骨折的风险。关于长期疗效，根据我们查阅的文献，PPI仍然是消化性溃疡病治疗的主要手段。
