Halloran L G, Nisman R M, Vlahcevic Z R
Va Med. 1978 Apr;105(4):284-96.
There have been remarkable recent advances in knowledge about duodenal ulcer, a disease which may be spontaneously disappearing. Multiple physiologic defects have been found including increased numbers of parietal cells and their increased sensitivity to gastrin, excessive gastrin release after food intake, decreased inhibition of gastrin release by low antral pH, more rapid gastric emptying, and, possibly, impaired duodenal mucosal resistance to acid. Antacid and diet therapies have been subjected to scientific scrutiny and their respective roles in the therapy of the duodenal ulcer are now better defined. New drugs have been developed which strongly inhibit gastric acid secretion in man--the recently marketed histamine H2-receptor antagonist, cimetidine, as well as chemically modified prostaglandins. Clinical trials have shown cimetidine to be effective in healing duodenal ulcers and free of significant side effects with short-term usage. Its role in the prevention of ulcer recurrence is presently being evaluated. A new operation for duodenal ulcer has been introduced which shows great promise following pilot studies and some randomized trials. Only the parietal cell containing portion of the stomach is denervated. Basal and stimulated gastric acid secretion are markedly inhibited while gastric motility is unimpaired. This operation thus eliminates the need for a drainage procedure or distal antral resection and decreases the incidence and severity of undesirable side effects associated with earlier operations for duodenal ulcer.
近年来，关于十二指肠溃疡的知识有了显著进展，这种疾病可能会自行消失。已发现多种生理缺陷，包括壁细胞数量增加及其对胃泌素的敏感性增强、进食后胃泌素过度释放、胃窦部低pH值对胃泌素释放的抑制作用减弱、胃排空加快，以及十二指肠黏膜对酸的抵抗力可能受损。抗酸剂和饮食疗法已接受科学审查，它们在十二指肠溃疡治疗中的各自作用现在已得到更明确的界定。已开发出能强烈抑制人体胃酸分泌的新药——最近上市的组胺H2受体拮抗剂西咪替丁，以及化学修饰的前列腺素。临床试验表明，西咪替丁在愈合十二指肠溃疡方面有效，短期使用无明显副作用。目前正在评估其在预防溃疡复发中的作用。一种治疗十二指肠溃疡的新手术已被引入，初步研究和一些随机试验显示其前景广阔。仅去除胃中含有壁细胞的部分的神经支配。基础胃酸分泌和刺激后的胃酸分泌均受到明显抑制，而胃动力未受损害。因此，这种手术无需进行引流手术或远端胃窦切除术，并降低了与早期十二指肠溃疡手术相关的不良副作用的发生率和严重程度。
