Medical Therapy of Peptic Ulcer Disease  

Oleh:

McQuaid, Kenneth R. ; Isenberg, Jon I

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The Surgical Clinics of North America (Keterangan: ada di ClinicalKey) vol. 72 no. 2 (Apr. 1992), page 285.

Isi artikel

Peptic ulcers occur when the damaging effects of acid and pepsin exceed the restorative processes that promote mucosal integrity and repair. A variety of factors have been identified that may favor the development of peptic ulcers in some patients, including gastric acid hypersecretion, NSAIDs, Helicobacter jnilori infection, and impaired mucosal bicarbonate secretion. The expansion in our understanding of ulcer pathogenesis has been paralleled by the development of a number of effective ulcerative therapeutic agents with varying mechanisms of action. Antisecretory therapy with H2-antagonists administered once daily is still the preferred approach for most patients with duodenal or gastric ulcers. The more potent acid suppression afforded by the H~/ K~-ATPase inhibitor omeprazole results in more rapid healing of ulcers, although its higher cost makes this a less attractive choice for many patients. Sucralfate also promotes peptic ulcer healing through ill-defined mucosal defensive properties; however, the need for multiple dosing is less attractive to most patients. Colloidal bismuth subcitrate (CBS) is equivalent to other agents in ulcer therapeutic efficacy, but it is not yet available in this country. Its principal advantage appears to be in the significantly lower ulcer recurrence rates observed after treatments with this agent. In the future, treatment directed toward eradication of H. pylon with CBS and antibiotics may become the desired first choice of treatment, especially in patients with refractory or complicated ulcer disease.

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