Department of Pharmacy, School of Chemical Sciences and Pharmacy, Central University of Rajasthan, Ajmer, India.
Department of Pharmacology, Amrapali Institute of Pharmacy and Sciences, Haldwani, India.
Horm Metab Res. 2024 Sep;56(9):615-624. doi: 10.1055/a-2256-6592. Epub 2024 Mar 11.
Peptic ulcers, recognized for their erosive impact on the gastrointestinal mucosa, present a considerable challenge in gastroenterology. Epidemiological insights underscore the global prevalence of peptic ulcers, affecting 5-10+% of individuals, with a yearly incidence of 0.3 to 1.9 cases per thousand. Recent decades have witnessed a decline in complications, attributed to improved diagnostics and therapeutic advancements. The review deepens into -associated and NSAID-induced ulcers, emphasizing their distinct prevalence in developing and industrialized nations, respectively. Despite advancements, managing peptic ulcers remains challenging, notably in -infected individuals facing recurrence and the rise of antibiotic resistance. The pathophysiology unravels the delicate balance between protective and destructive factors, including the intricate molecular mechanisms involving inflammatory mediators such as TNF-α, ILs, and prostaglandins. Genetic and ethnic factors, rare contributors, and recent molecular insights further enhance our understanding of peptic ulcer development. Diagnostic approaches are pivotal, with upper gastrointestinal endoscopy standing as the gold standard. Current treatment strategies focus on eradication, NSAID discontinuation, and proton pump inhibitors. Surgical options become imperative for refractory cases, emphasizing a comprehensive approach. Advances include tailored regimens, the emergence of vonoprazan, and ongoing vaccine development. Challenges persist, primarily in antibiotic resistance, side effects of acid suppressants, and translating natural compounds into standardized therapies. Promising avenues include the potential vaccine and the exploration of natural compounds, with monoterpenes showing therapeutic promise. This review serves as a compass, guiding healthcare professionals, researchers, and policymakers through the intricate landscape of peptic ulcer management.
消化性溃疡是一种常见的胃肠道黏膜侵蚀性疾病，给消化内科带来了巨大挑战。流行病学研究表明，全球范围内有 5-10%的人患有消化性溃疡，年发病率为每千人中有 0.3-1.9 例。近年来，由于诊断技术的提高和治疗方法的进步，消化性溃疡的并发症发生率有所下降。本综述深入探讨了与消化性溃疡相关的问题，包括与幽门螺杆菌感染和非甾体抗炎药（NSAID）相关的溃疡，强调了它们在发展中国家和发达国家的不同流行情况。尽管取得了进展，但消化性溃疡的管理仍然具有挑战性，特别是在感染幽门螺杆菌的患者中，他们面临着溃疡复发和抗生素耐药性上升的问题。病理生理学揭示了保护性和破坏性因素之间的微妙平衡，包括涉及 TNF-α、ILs 和前列腺素等炎症介质的复杂分子机制。遗传和种族因素、罕见因素以及最近的分子研究进一步增强了我们对消化性溃疡发病机制的理解。诊断方法至关重要，上消化道内镜检查是金标准。目前的治疗策略侧重于幽门螺杆菌根除、停止使用 NSAID 和质子泵抑制剂。对于难治性病例，手术治疗是必要的，强调了综合治疗的重要性。进展包括个体化治疗方案、沃诺拉赞的出现以及疫苗的不断研发。挑战依然存在，主要包括抗生素耐药性、酸抑制剂的副作用以及将天然化合物转化为标准化治疗方法的困难。有前途的研究方向包括可能的疫苗和天然化合物的探索，其中单萜类化合物显示出治疗潜力。本综述为医疗保健专业人员、研究人员和政策制定者提供了一个指导，帮助他们在消化性溃疡管理的复杂领域中前行。
