Download Gastric Cytoprotection: A Clinician’s Guide by André Robert (auth.), Daniel Hollander M.D., Andrzej S. PDF

By André Robert (auth.), Daniel Hollander M.D., Andrzej S. Tarnawski M.D., D.Sc. (eds.)

Gastric secretions include hydrogen ions at a focus that's multiple million instances better than their intracellular focus. This extra special gradient in addition to the validated skill of gastric juice to digest tissues has stimulated clinicians and investigators alike to stress acid secretion and acid ablation in learning the pathogenesis and treatment of peptic ulcer ailment. Conse­ quently, during the last one hundred fifty years, we now have made massive development in less than­ status the mechanisms and law of acid secretion by way of the tummy. now not unusually, remedy for either peptic illness and mucosal harm has additionally been predominantly directed at both neutralizing acid or suppressing its construction. in past times 10 years, recognition has been eager about components except acid within the genesis and treatment of ulcer disorder. paintings performed all over the world demon­ strated that acid hypersecretion isn't a typical occasion in peptic ulcer disorder. for that reason, we started knowing that components except acid secretion will be vital within the genesis of ulcer ailment or in gastroduodenal mucosal harm. moreover, new physiological details has confirmed that the fuel­ troduodenal mucosa is generally secure via a fancy sequence of occasions includ­ ing mucus and bicarbonate secretion, telephone renewal, floor mucosal restitution, and upkeep of the microvasculature and mucosal proliferative zone.

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In this connection, some obviously important problems remain unresolved. For example, if gastric juice is so corrosive, why do not the stomach and duodenum undergo continuous and progressive digestion? Why are ulcers usually so discrete and localized? The attempted solutions have always involved additional hypotheses and assumptions involving such concepts as defensive factors. These latter assumptions are unnecessary if gastric juice is not corrosive. 6. Bias Many aspects of the etiologic analyses of ulcer disease involve serious biases of different types.

Table II. , histamine, leukotrienes, fibrinopeptides) Formation of necrosis Exfoliation of necrotic mass Erosions and/or ulcers Pathomorpbology of Gastric Mucosal Injury 43 Inflammatory Changes in the Gastric Mucosa Inflammation of the gastric mucosa may predispose it to injury and ulcer disease. Recently, Campylobacter pyloris-a spiral, gram-negative bacillushas been rediscovered as a potential cause of chronic active antral gastritis. Endoscopic and histological examinations have shown that eradication of the bacillus brings normalization to the gastric antral mucosa and perhaps reduces the recurrence rate of ulcer disease.

1. Antiulcer Drugs Antacids have been shown to increase significantly the rate of healing of duodenal ulcers. Antacids have long been assumed to exert their therapeutic effects by buffering acid and thereby inactivating pepsin, although recently the doses of antacids used to heal ulcers have become so small that the buffering capacity of the ingested antacid is no longer adequate to dispose of more than a small fraction of the acid secreted by most patients with duodenal ulcer. The mechanism whereby antacids heal ulcers remain to be defined.

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