治疗胃肠道疾病药物消化性溃疡（pepticulcer）为消化系统最常见疾病，发病率约8%~10%。为一种慢性疾病，可反复发作，病情持续数年至数十年，可发生于消化道任何部位，最多见于胃和十二指肠溃疡。胃溃疡多位于胃小弯近幽门处，十二指肠溃疡一般位于球部。一、病因及发病机制攻击因子（致溃疡因素）胃酸过多：各种刺激引起胃酸和胃蛋白酶分泌，产生自身消化作用。有“无酸不成溃疡”的说法。幽门螺杆菌（Helicobacterpylori,Hp）：寄生在胃粘液层之下，破坏粘液层，减弱其保护作用。是溃疡病长期不愈，反复发作的重要因素。药物：阿斯匹林及非甾体类抗炎药胆汁和十二指肠液的反流：可破坏胃粘膜，刺激G细胞分泌胃泌素促胃酸分泌。防御因子（抗溃疡因素）粘膜屏障：粘液-碳酸氢盐屏障（胃腔中pH常<2，粘液下为7），粘膜上皮的紧密连接。局部血液循环：胃肠激素及细胞保护因子：前列腺素，表皮生长因子幽门括约肌功能：十二指肠逆蠕动及幽门松弛Theacid-pepticdiseases7Enterochromaffin-Like(ECL)CellsEnterochromaffin-Like(ECL)Cells二、主要临床表现二、诊断依据三、主要并发症Left:Anelderlypatientpresentswithmelenaandhypotension.Right:35-year-oldwomanpresentswithtarrystoolsandahemoglobinof75g/L.Gastriculcerwithpunched-outulcerbasewithwhitishfibrinoidexudates.Thisimageshowsabenigngastriculcerasseenwithabariumstudy.Notethetypicallocation(lessercurvature),withtheulcerprojectingbeyondthecontourofthestomach.PepticUlcerDiseaseAlthoughpepticulcersproduceavarietyofsymptoms,noneisspecificforthedisease.Severepainorarapidincreaseinpainsuggestsanulcercomplicationoranotherdiagnosis;associateddyspepsiasymptomsincludenausea,bloating,heartburn,andbelching.Indeed,pepticulcersarethemostcommoncauseofacuteupperGIbleedingHpylorieradicationand/orantisecretorytherapiesarethemainstayoftoday'streatmentstrategies.四、治疗溃疡病药物分类抗酸剂：氢氧化铝，三硅酸镁，碳酸钙等，起中和胃酸作用，现已很少用。抑制胃酸分泌：H2受体阻断剂：西咪替西，雷尼替丁，法莫替丁H+-K+-ATP酶抑制剂（质子泵抑制剂）：奥美拉唑，兰索拉唑其他还有M受体阻断剂和胃泌素受体阻断剂胃粘膜保护剂：前列腺素E，枸橼酸铋钾，硫糖铝杀灭幽门螺杆菌：三联疗法：枸橼酸铋、甲硝唑、羟氨苄青霉素二联疗法：奥美拉唑、甲红霉素，或加羟氨苄青霉素三联疗法AcidPepticDiseasesPharmacologicalApproachtoTreatmentDrugsModulatingGastricAcidAntacidsH2-receptorAntagonists特点：H2RAsmainlyinhibitbasalrateofacidreleaseduringnonfeedingperiods.Thisisofparticularimportanceduringthenocturnalperiodsoffasting,whichistherationalfortheuseofH2RAdosingatbedtime.TheH2RAsareoftenadministeredonceadaypriortobedtimetomaximallyimpactnocturnalbasalacidsecretion.Allagentshavelinearpharmacokineticsandareeliminatedprimarilybyrenalmechanisms.Doseadjustmentsareneededforpatientswithrenalimpairment.H2RAs