胃酸相關胃腸疾病之最新診治新進展

The New Development on Management of Acid-related Gastrointestinal Diseases

林淳榮(Chun-Jung Lin)

《內科學誌》 26卷3期 (2015/06) Pp. 123-132

https://doi.org/10.6314/JIMT.2015.26(3).01

摘要

胃酸的功用除了幫助消化蛋白質，與吸收礦物、B12外，尚可抑制細菌生長與腸道感染。工業革命後，胃酸造成的併發症嚴重影響人類健康。尤其是消化性潰瘍與穿孔，是外科開刀治療之主因。但隨著神經生理學與內分泌學之進展，迷走神經與胃泌素被認定是控制胃酸分泌之主要因素；後來壁細胞分泌胃酸之調控機制與質子幫浦的發現，陸續有Histamine2拮抗劑，與質子幫浦抑制劑（PPI）成為控制胃酸的藥物，使胃酸相關疾病成為內科治療為主之疾病。胃內幽門桿菌的發現與胃炎，潰瘍之致病機轉的解密，近年來使得根治潰瘍與降低胃癌的發生成為可能。但緊接著胃食道逆流症隨著幽門桿菌消失，與西化飲食改變與肥胖盛行，成為影響人類作息與生活品質的困擾疾患。即使有推陳出新更強的新一代質子幫浦抑制劑問世，仍有無法滿足治療需求之憾；而且抗生素的濫用使有抗藥性之幽門桿菌迅速出現，老年人口中NSAID的使用量激增，潰瘍與上消化道出血又再次逆襲人類的健康。本文藉著回顧胃酸生理研究史與最新制酸藥物的介紹，佐以近年來台灣醫界在消化醫學上之研究概論與貢獻，期望能對胃酸相關之胃腸疾病診治共識中，尋得一條解決之最佳途徑。

關鍵字

壁細胞 ； 消化性潰瘍 ； 胃食道逆流症 ； 非糜爛性逆流症 ； 質子幫浦抑制劑

並列摘要

Gastric acid played an important role on human protein digestion, absorption of some minerals and vitamin B12, as well as bactericidal effect. However excess acid might cause serious implication on health, such as peptic ulcer and perforation, which were used to resort to surgical intervention since industrial revolution. Following the elucidation of neurophysiology and endocrinology, gastric acid secretion was known to be mainly controlled by vagal nerve and gastrin. Through the research of acid manufactory- parietal cells, histamine2 blockers and proton pump inhibitors were introduced and marketed as main regulators of gastric acid, resulting in successful medical treatment on almost whole acid-related diseases. Then the discovery of Helicobacter pylori in stomach and its pathogenesis on gastritis and peptic ulcer made the eradication of bacteria and peptic ulcer disease possible. However the evolution of gastroesophageal reflux disease (GERD) takeover worldwide as main acid-related disease, affecting the quality of life on millions of people nowadays. Despite of the refinement of new PPIs, there is still unmet clinical need on treatment. GERD will be highlighted as increased trends as Barrett's esophagus and esophageal adenocarcinoma after eradication of H. pylori. Following the emerging resistant strain from widespread antibiotic administration and increased usage of NSAID on elderly, peptic ulcer and gastrointestinal bleeding seemed to resurge again. This article will cover the histological perspective, concerning acid research and introduce some contributory studies from Taiwan, as well as update on management consensus of acid-related diseases. This brief text was expected to give us some important clinical insights into these issues for better future practice.

並列關鍵字

Parietal cells ； Peptic ulcer ； Gastroesophageal reflux disease, GERD ； Nonerosive reflux disease, NERD ； Proton pump inhibitors, PPI