Deveney C W, Deveney K E
Surg Annu. 1985;17:219-33.
Since duodenal ulcer can be treated effectively with several drugs (H2 receptor antagonists, sucralfate, colloidal bismuth or antacids) the choice of drug should be determined by cost, ease of administration, and lack of side effects. The H2 receptor antagonists and sucralfate cost about the same and have few side effects. They should both be considered first-line drugs for treatment of duodenal ulcer. Colloidal bismuth is not available for use in the United States, but should be otherwise included in this group. Antacids must be taken more often than H2 receptor antagonists; the liquid antacids are messy, will produce diarrhea in many patients, and have several other side effects that make them a second-choice drug. Although the tricyclic selective anticholinergic pirenzepine has been effective in treating duodenal ulcer, it is not approved in the United States and its role in the treatment of duodenal ulcer is not yet well defined. The only role for pirenzepine presently is as a second drug with the H2 receptor antagonists in the treatment of acid hypersecretion in the Zollinger-Ellison syndrome. The same principles apply in the treatment of gastric ulcers as in duodenal ulcers, with a few exceptions. Gastric ulcers probably respond less to antacids than to H2 receptor antagonists or coating agents such as sucralfate, and preliminary data suggest that long-term maintenance therapy with H2 receptor antagonists to prevent ulcer recurrence is not as effective with gastric ulcers as it is with duodenal ulcers. Several compounds will promote the healing of duodenal and gastric ulcers. These compounds have minimal side effects and are well tolerated by patients. They are without question highly effective acutely, but when discontinued they have no lasting influence on the chronic nature of peptic ulcer disease, and their role in the long-term treatment of peptic ulcer disease is unclear. Thus, whether or not these drugs will actually reduce the need for surgical treatment of peptic ulcer disease remains to be determined.
由于十二指肠溃疡可用多种药物（H2受体拮抗剂、硫糖铝、胶体铋或抗酸剂）有效治疗，药物的选择应根据成本、给药便利性和无副作用来决定。H2受体拮抗剂和硫糖铝成本大致相同，且副作用较少。它们都应被视为治疗十二指肠溃疡的一线药物。胶体铋在美国无法使用，但在其他方面应归入此类。抗酸剂必须比H2受体拮抗剂更频繁服用；液体抗酸剂使用不便，会使许多患者腹泻，还有其他几种副作用，使其成为二线药物。尽管三环类选择性抗胆碱能药哌仑西平在治疗十二指肠溃疡方面有效，但在美国未获批准，其在十二指肠溃疡治疗中的作用尚未明确界定。哌仑西平目前唯一的作用是作为与H2受体拮抗剂联合使用的第二种药物，用于治疗卓-艾综合征的胃酸分泌过多。治疗胃溃疡的原则与十二指肠溃疡相同，但有一些例外。胃溃疡对抗酸剂的反应可能不如对H2受体拮抗剂或硫糖铝等包衣剂的反应，初步数据表明，用H2受体拮抗剂进行长期维持治疗以预防溃疡复发，对胃溃疡的效果不如对十二指肠溃疡的效果。有几种化合物可促进十二指肠溃疡和胃溃疡的愈合。这些化合物副作用极小，患者耐受性良好。它们在急性期无疑非常有效，但停药后对消化性溃疡病的慢性性质没有持久影响，其在消化性溃疡病长期治疗中的作用尚不清楚。因此，这些药物是否真的会减少消化性溃疡病手术治疗的需求仍有待确定。
